THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

LOS  ANGELES 


LOS  ANGELES  COUNTY 
FREE  LIBRARY 

610.4  Bridge 

Mental  therapeutics , 
and  other  papers.       1 


REFERENCE 


Mental  Therapeutics 


BOOKS  BY  THE  AUTHOR 

1 — The  Penalties  of  Taste 

Duffield 

2 — The  Rewards  of  Taste 

Duffield 

3 — House-Health 

Duffield 

4 — Fragments  and  Addresses 

Bireley  &  Elson 
Los  Angeles 

5 — Tuberculosis — Lectures 

Saunders 

6 — The  Marching  Years 

Duffield 

7 — Mental  Therapeutics  and  Other 
Papers 

Duffield 


Mental  Therapeutics 

AND  OTHER  PAPERS 


BY 


NORMAN  BRIDGE 

M.D.,  A.M.,  LL.D. 


DUFFIELD  &  COMPANY 
NEW    YORK 

MCMXXII 


COPYRIGHT,  1922.  BY 
NORMAN  BRIDGE 


Published  April,  1922 


PRESS  OF 

BIKKLEY  <t  ELSON  PRINTING  Co. 

LOS  ANGELES 


Ki 


CONTENTS 


MENTAL  THERAPEUTICS 


THE  ECONOMIC  WASTE  OF  SICKNESS  AND 

PREMATURE  DEATH 33 

A  DEFRAUDATION  OF  YOUTH 63 

A  PRESENTATION  ADDRESS 85 

EPHRAIM  FLETCHER  INGALS — THE  MAN    ...  97 

HENRY  BACHMAN  STEHMAN Ill 

ON  THE  HISTORY  OF  OIL 117 

LOOKING  AHEAD 137 

HOSPITALS  AND  NURSES 161 

CADET  NURSES  AND  HOME  NURSING    ....  171 

To  E.  P.  R.  ON  ATTAINING  His  SEVENTIETH 

YEAR  179 


,,.r>  /•  rx 
• - 


Mental  Therapeutics 


Mental  Therapeutics* 


Man's  mental  state  is  responsible  for  many 
of  his  sensations.  An  emotion  can  make  him 
happy  or  unhappy;  it  may  cause  him  to  blush 
or  blanch,  to  perspire  freely  and  to  shake  with 
fear;  it  may  fill  his  mouth  with  saliva  or  dry 
it  in  an  instant;  and  it  may  suddenly  stop  his 
digestion.  It  is  claimed  that  intense  emotion 
can  turn  the  hair  gray  in  a  few  hours.  It  may 
cause  a  sudden  intense  pain  in  the  head  or  else- 
where; may  make  the  pulse  irregular,  and  the 
heart  to  beat  with  such  violence  as  to  rupture  a 
cerebral  vessel;  and  it  may  cause  death  by  the 
sudden  giving  out  of  the  few  remaining  muscu- 
lar fibres  of  a  degenerate  heart. 

On  the  other  hand,  an  emotion  may  drive 
away  pain  and  discomfort,  indigestion  and 
sleeplessness,  and  turn  grief  into  joy,  and  make 
a  change  in  the  governing  impulse  to  action 
that  may  continue  through  life. 

Irritability  may  cause  one  to  be  annoyed  by 
trifles,  and  life  to  be  made  a  continuous  torture. 


*Being   a   revision    of    "The    Mind   for   a   Remedy"    in    the 
author's   book   "The  Rewards   of  Taste" — 1902. 


MENTAL  THERAPEUTICS 

A  contrary  emotion  may  beget  good  temper  in 
the  midst  of  all  the  cumulative  annoyances  of 
life.  Emotion  with  an  idiosyncrasy  or  a  weak- 
ness makes  many  of  the  forms  of  hysteria,  as 
cultivation  of  the  right  emotions  may  prevent 
these  symptoms. 

Right  emotions  are  sought  always,  and  prob- 
ably by  everybody.  Everybody  would  be  happy 
if  he  could.  If  an  emotion  can  drive  away 
pain  and  increase  tranquillity,  every  one  who 
knows  about  it  would  naturally  cultivate  it. 
Nobody  would  willingly  seek  mental  states  that 
give  him  pain  and  indigestion,  unhappiness  and 
insomnia. 

A  thousand  guide  posts  have  directed  men 
to  the  emotions  that  promise  peace  and  freedom 
from  suffering  and  discontent.  Many  of  these 
are  religious;  hundreds  of  different  shades  of 
faith,  and  with  all  sorts  of  inspiration  and 
philosophy.  The  range  is  wide,  and  all  kinds 
of  spirits  and  gods,  and  one  God  and  Jesus 
Christ,  are  invoked  in  manifold  variations;  and 
people  are  told  that  by  embracing  this  or  that 
particular  form  they  shall  have  some  physical 
or  spiritual  advantage  not  given  to  the  rest  of 
mankind. 

Some  religions  are  urged  upon  unbelievers 
for  the  purpose  of  spiritual  safety  after  death, 
with  incidental  advantages  in  this  life;  others, 
like  one  of  the  latest,  are  advocated  because 


MENTAL  THERAPEUTICS 

they  promise  to  rid  the  body  of  disease  and 
bring  happiness  and  harmony  here — with  cer- 
tainty of  happiness  in  the  hereafter.  One 
teaches  that  disease  may  be  cured  by  prayer; 
another,  that  disease  is  an  imaginary  thing  and 
that  if  you  only  understand  it  does  not  exist, 
it  does  not;  still  another,  that  the  laying-on 
of  hands  or  some  weird  gestures  made  over  the 
patient  will  cure.  One  cult  says  that  the 
human  mind  has  a  chemical  quality  and  must 
learn  to  attract  the  desirable  thoughts  and  emo- 
tions, and  to  repel  those  of  an  opposite  sort, 
as  chemical  elements  do.  One  writes  of  the 
majesty  of  calmness,  another,  of  the  wonders 
and  the  power  of  relaxing  to  give  joy  and 
strength;  and  another  has  convinced  a  consid- 
erable company  that  the  great  enemies  of  the 
race,  and  the  potent  makers  of  grief  and  sick- 
ness, are  the  emotions  of  anger  and  worry — 
two  allied  emotions,  and  doing  a  vast  amount 
of  mischief. 

There  can  be  no  doubt  of  the  value  of  these 
influences  for  relief  to  many  people  in  various 
states  of  physical  and  mental  trouble.  They 
have  by  their  own  testimony  received  help  and 
strength  from  them.  There  can  be  no  doubt  of 
this  fact.  If  the  help  has  come  through  the 
imagination,  that  is  an  explanation  of  the 
method  and  does  not  impeach  the  claim.  So 
the  treatment  of  the  sick  is  not  confined  to 
medicines  alone;  other  influences  are  quite  as 


MENTAL  THERAPEUTICS 

valuable,  even  indispensable.  People  often  do 
get  well  of  painful  disorders,  if  not  dangerous 
ones,  with  the  aid  of  helpful  emotions. 

Probably  all  of  these  influences  have  some 
power,  and  for  different  classes  of  people  dif- 
ferent values.  Some  of  the  measures  are  ap- 
plicable to  one  person,  some  to  another,  depend- 
ing on  their  respective  idiosyncrasies.  That  the 
measures  apply  at  all,  and  do  good  in  some 
cases,  is  a  lesson  that  scientific  medicine  ought 
not  to  lose.  It  must  be  confessed  that  in  the 
main  physicians  have  almost  wholly  failed  to 
use  for  any  good  purpose  these  surprising 
influences. 

The  catalogue  is  a  long  one  of  the  conditions 
of  body  and  mind  in  which  these  influences 
work.  It  includes  a  large  series  of  aches  and 
pains,  and  of  odd  sensations  like  numbness  and 
tingling,  sometimes  called  paresthesia.  It  in- 
cludes some  faults  of  the  functions  of  the 
body  that  are  usually  supposed  to  be  wholly 
uninfluenced  by  mental  states  as,  for  example, 
many  forms  of  bad  digestion,  and  irregular 
action  of  stomach  and  intestines.  It  includes 
a  wide  range  of  mental  perturbations,  as  in- 
somnia, worry,  anger,  brain  and  nerve  fatigue, 
hysteria  in  numerous  forms,  and  all  that  com- 
bination of  symptoms  called  neurasthenia.  This 
word  always  means  a  worn-out  or  run-down 
condition  of  the  mechanism  of  the  brain  that 


MENTAL  THERAPEUTICS 

is  engaged  in  mental  attention,  in  care-taking, 
and  in  liking  or  disliking  people  and  things; 
and  in  the  function  of  ideation — or  plain  think- 
ing. Doubtless  the  brain  and  spinal  cord  are 
always  involved  together  in  these  cases,  but  the 
brain  most.  The  disorders  are  true  psycho- 
neuroses,  a  term  that  covers  most  forms  of  so- 
called  hysteria  and  neurasthenia. 

The  influences  named  work  for  benefit  in 
various  ways;  first  by  arousing  expectation  of 
relief ;  then  by  reducing  such  emotions  as  wear 
upon  the  nervous  susceptibility,  as  worry,  an- 
ger, suspiciousness,  fear,  jealousy,  pride  in  dan- 
ger, anxiety  and  sense  of  care  and  duty,  and  the 
emotional  states  of  diffidence,  mental  tension 
— a  nervous  low  flash  point.  These  bad  emo- 
tions are  often  overcome  and  displaced  by  new 
and  better  ones,  such  as  hope,  faith,  love,  aspi- 
ration, serenity,  relaxation  and  imperturbability. 
These  help  one  to  endure  without  friction  a 
flood  of  trouble  and  care  that  otherwise  would 
be  unbearable. 

How  these  measures  may  be  practically  ap- 
plied and  the  old  emotions  displaced  by  the 
new;  and  whether  to  any  degree  mystery  or 
deception  are  justifiable  in  general,  and  to  be 
fostered  for  either  party  (the  one  who  needs 
the  relief  or  the  one  who  tries  to  give  it)  are 
serious  questions  that  deserve  the  best  study. 

In  some  cases,  and  for  some  people  it  is  not 
a  question  of  the  need  of  mystery  to  accomplish 


MENTAL  THERAPEUTICS 

the  required  purpose,  for  that  is  a  certainty. 
Many  people  never  can  be  appealed  to  on  a 
wholly  rational  basis  for  any  emotional  effect ; 
they  cannot  use  their  own  unmysterious  powers 
for  their  own  relief.  The  only  question  is  how 
far  scientific  caretakers  of  the  sick,  who  them- 
selves are  not  deluded  or  wool-blind,  shall  fos- 
ter the  idea  of  mystery  and  perhaps  super- 
natural power  in  dealing  with  invalids,  and 
just  what  their  procedure  and  sequence  of 
action  ought  to  be. 

Our  ambition  always  must  be  for  an  unworn- 
out  thinking  machine  that  is  not  too  emotional ; 
this  is  the  goal,  and  that  gained,  all  else  is  easy. 
How  to  reach  it  is  the  problem.  In  all  cases 
of  so-called  nervous  prostration  the  chief  de- 
sideratum must  be  (after  or  with  restoration 
of  bodily  functions)  to  rest  the  brain  machin- 
ery that  is  tired;  i.  e.,  change  the  trend  of 
thought ;  give  new  scenes  and  occupations  and 
stop  the  regular  work.  But  this  is  not  enough ; 
we  must  change  the  current  emotions  and  in- 
duce new  thoughts  not  connected  with  the  voca- 
tion or  the  things  that  have  worried  the  victim 
and  damaged  the  endurance.  This  last  meas- 
ure is  the  most  potent  of  all  influences,  and  is 
usually  possible  of  realization.  Hope  and  faith 
can  take  the  place  of  despair  and  doubt,  sus- 
picion and  melancholy.  Tranquillity  and  relax- 
ation can  come  instead  of  incessant  tension,  ap- 
prehension and  exalted  alertness.  Imperturb- 

8 


MENTAL  THERAPEUTICS 

ability  may  stand  instead  of  fret,  irritability, 
diffidence  and  fear;  and  benevolence  and  un- 
selfishness instead  of  hate,  envy  and  jealousy. 
The  difficulty  is  to  know  how  to  bring  these 
changes  to  people  of  all  sorts  of  mental  pecu- 
liarities and  crotchets,  as  well  as,  perhaps,  of 
moral  perversity.  When  the  transformation 
begins  we  discover  a  new  being.  A  new  birth 
in  thought  and  freedom  has  occurred.  The 
change  manifestly  cannot  come  to  all  people, 
only  to  most  of  them  for  whom  the  best  efforts 
are  made  by  themselves  or  others.  There  are 
at  least  three  cardinal  forces  that  start  the 
process.  They  may  be  stated  thus : 

1.  The  power  of  the  victim  himself,  as  in 
the  few  instances  where  he  knows  his  failings, 
and  changes  intelligently.     He  knows  he  has 
overworked  and  resolves  to  rest ;  he  has  fretted 
too  much  and  has  been  governed  by  ignoble 
purposes,  and  resolves  to  change,  and  does  it. 
Such  people  are  the  greatest  and  grandest  in 
all  the  world. 

2.  The  help  of  others  who  know  better  than 
the  patient  what  his  failings  are  and  who  point 
the  way  in  a  rational  and  kindly  manner.  These 
others  are  the  friend,  the  doctor  and  the  priest, 
who  can  persuade  and  convince  without  arous- 
ing that  most  formidable  obstacle — the  notion 
that  unpleasant  advice  is  unfriendly. 

3.  Some   new   influence  brought   into   the 
mind  that  can  change  the  bad  emotional  bent, 


MENTAL  THERAPEUTICS 

as  some  mystery  or  mysticism,  some  novelty 
or  humbug,  or  a  belief  in  the  power  of  some- 
thing beyond  himself  on  which  the  patient 
leans  or  believes  he  leans. 

These  last — except  when  believers  in  a  whole- 
some religion  urge  a  reliance  on  divine  power 
to  help  one  to  lift  himself — are  usually  brought 
to  the  patient  by  the  psychic,  the  quack,  the 
believer  in  strange  things,  the  mesmerizer,  the 
intentional  fakir,  or  the  religious  doctrinaire 
who  is  himself  deluded.  And  the  doctrines 
strike  people  in  a  thousand  different  ways,  and 
find  as  many  shades  of  criticism,  doubt,  cre- 
dulity and  blindness. 

Probably  the  mystery  cannot  be  dispensed 
with  for  all  people  at  all  times.  Some  must 
have  it  in  one  form  or  another,  and  it  is  not 
true  that  any  of  them  wish  to  be  humbugged ; 
but  they  are  susceptible  to  influences  that  come 
in  the  guise  of  mystery,  and  they  cannot  help 
it,  nor  learn  to  help  it  much.  And  the  mystery 
is  sure  to  come  in  one  shape  or  another  to  sus- 
ceptible natures,  for  all  time.  It  has  been  so 
through  the  history  of  the  race,  and  there  is  no 
ground  to  expect  that  it  will  change  greatly. 
Wonderful  effects  from  mysterious  things,  like 
secret  nostrums  and  occult  influences,  will  con- 
tinue to  be  recorded  hereafter  as  they  have  been 
heretofore. 

The  fact  that  the  disorders  and  patients  de- 
scribed have  been  the  objects  of  charlatanry 

10 


MENTAL  THERAPEUTICS 

so  long,  is  no  reason  why  we  should  not,  in 
their  behalf,  resort  to  mental  effects  that  are 
possible  for  good,  and  that  are  founded  on 
the  physiology  of  the  brain  and  nervous  sys- 
tem. Indeed,  the  scandals  of  the  past  are  a 
sufficient  reason,  if  there  were  no  other,  for 
considering  this  subject  in  a  dispassionate  and 
scientific  manner.  But  the  pathetic  condition 
of  a  large  class  of  nervous  patients  is  another 
reason,  and  they  deserve  the  best  thought  and 
talent  of  all  experts  in  these  very  directions. 

As  to  the  situations  and  influences  here  re- 
ferred to;  and  to  all  cases  of  sickness  that 
are  at  all  chronic,  whatever  may  be  their 
degree  of  severity  or  their  peculiarity,  it  is 
clear  that  the  doctor  has  certain  very  positive 
duties.  As  I  conceive  them,  they  are: 

To  see  what  brain  and  nerve  powers  and 
functions  have  gone  wrong  or  are  out  of 
order,  as  shown  by  the  mental  and  nervous 
symptoms,  or  otherwise. 

To  discover  what  functions  of  the  body  are 
wrong,  that  have  been  made  so  by  mental 
influences,  or  that  have  caused  the  nervous 
disorder. 

To  study  the  personal  qualities  of  individual 
patients  and  see  how  each  can  be  affected  in 
the  best  way  by  psychopathic  as  well  as  other 
influences,  and  to  apply,  with  care  and  dis- 
cretion, such  measures  as  are  found  necessary 
for  each  case. 

11 


MENTAL  THERAPEUTICS 

The  first  of  these  duties  it  would  seem  pos- 
sible to  do  easily;  yet  it  is  not.  Doctors  are 
much  more  inclined  to  prescribe  drugs  or 
physical  means  for  the  supposed  disease  that 
they  guess  to  be  the  cause  of  the  symptoms, 
than  to  even  seek  for  some  causation  in  mental 
or  emotional  conditions.  Indeed,  as  we  study 
the  sick,  we  too  often  forget  all  about  the  physi- 
ology of  the  nervous  system,  and  especially 
the  relation  of  the  more  voluntary  to  the  more 
involuntary  portions  of  it.  If  we  would  only 
try  to  know  what  powers  and  functions  of  the 
brain  are  going  wrong,  we  could,  I  believe, 
often  prevent  insanity  from  occurring.  And 
it  is  not  difficult  when  we  study  a  patient  care- 
fully, and  have  his  confidence,  to  know  whether 
his  emotional  and  mental  life  are  right  or 
wrong,  and  if  wrong  what  they  need  for  cor- 
rection. His  insomnia  is  produced  often  by 
some  annoying  emotion;  his  loss  of  memory 
by  introspection  and  worry,  perhaps  over 
imaginary  bodily  ills;  his  lightning  nervous 
response  by  overwork  and  wrong  emotional 
attitude  toward  his  environment.  So  of  many 
other  mental  and  bodily  symptoms.  The  fine 
art  of  the  doctor  is  to  gain  the  confidence  of 
the  patient  so  that  he  will  reveal  that  part  of 
his  inner  life  which  he  usually  hides  completely. 

As  to  the  second  duty,  to  see  if  physical 
functions  are  disturbed  by  mental  forces,  we 
almost  never  think  of  it.  It  does  not  occur 

12 


MENTAL  THERAPEUTICS 

to  us  that  a  pain  could  be  so  produced,  or 
indigestion  or  a  coated  tongue.  And  the  sug- 
gestion that  one  could  have  a  hemorrhage 
from  the  lungs  or  throat  from  the  effect  of 
emotion  seems  preposterous.  Yet  I  have 
known  beyond  a  peradventure  such  cases. 
Many  cases  of  indigestion  are  made  worse, 
if  not  produced,  by  eating  hurriedly  in  a  state 
of  mental  tension,  or  under  depressing  emo- 
tions of  the  class  that  are  removable  by  other 
emotions  invoked  to  displace  them.  Dyspep- 
tics are  accused  of  malingering  because  some- 
times they  can  eat  with  impunity  articles  and 
quantities  of  food  that  usually  cause  them  acute 
suffering.  The  fact  is  that  with  the  right 
emotions  digestion  is  better;  with  the  usual 
ones  it  is  worse.  A  dinner  with  friends  and 
good  feeling,  and  without  cares  or  sense  of 
haste,  is  a  very  different  thing  from  bolting  a 
little  of  even  the  best  food  under  the  pressure 
of  worry  from  any  cause. 

That,  with  many  persons,  a  moderate  pain 
is  made  worse  to  their  consciousness  by  their 
thinking  and  talking  about  it,  and  by  their 
friends  magnifying  it,  is  as  notorious  as  it  is 
that  the  pain  is  often  gone  the  moment  they 
can  ignore  it.  Yet  we  rarely  make  the  small- 
est suggestion  of  mental  influence  in  this  class 
of  cases.  We  seldom  ask  ourselves  whether 
a  pain  is  made  worse  by  thinking  on  it,  and  if 
we  do,  and  find  such  is  the  case,  we  are  liable 

13 


MENTAL  THERAPEUTICS 

to  scold  the  patient  or  lose  interest  in  him  for 
this  reason,  when  we  ought  to  have  the  more 
interest,  and  might  convince  him  of  the  mental 
element  to  his  benefit.  We  could  also  enlist 
his  friends  to  help  him  forget  the  pain,  which 
is  usually  the  reverse  of  what  they  do.  In- 
stead he  usually  gets  a  round  of  anodynes 
which  are  not  completely  effective,  while  he 
grows  more  and  more  alive  to  his  sufferings, 
until  his  emotional  condition  becomes  ripe  for 
his  being  lulled  into  forgetfulness  of  the 
pain  by  any  faith  remedy  or  mental  legerde- 
main that  may  be  offered.  The  feeling  of 
desperation  has  been  reached  where  the  victim 
will  grasp  at  any  straw  of  hope.  A  promise 
of  positive  relief  is  the  greatest  boon  of  all, 
and  that  is  the  pledge  of  the  new  remedy, 
whatever  it  is. 

That  the  relief  is  complete  in  so  many  cases 
is  proof  that  there  are  a  great  many  imaginary 
and  functional  sufferers.  It  is  proof  also  of 
what  the  doctor  could  do  if  he  would  try. 
Serious  organic  diseases  do  not  get  well  by 
such  influences,  but  they  are  a  minority  of  all 
the  cases  of  sickness.  That  as  a  rule  there 
must  be  some  lessening  in  the  intellectual  grasp 
of  the  normal  relation  of  things,  the  usual 
sense  of  proportion,  when  a  person  can  give 
himself  over  to  such  faith  in  mystery,  does 
not  help  the  matter  nor  excuse  us.  Moreover 
there  are  exceptions  to  this  rule  in  the  few 

14 


MENTAL  THERAPEUTICS 

strong  minds  to  whom  some  supposed  novel 
phenomena  seem  inexplicable  save  on  the  the- 
ory of  supernatural  power;  and  they  ignore 
their  logic  as  a  thing  that  has  played  them 
false.  The  claim  made  by  some  writers  that 
these  people  are  verging  toward  true  insanity 
is  not  correct,  but  is,  I  presume,  suggested  by 
some  of  their  own  fixed  theories  about  mental 
action.  Fixed  theories  more  than  our  logic 
are  prone  to  play  us  false. 

The  third  consideration  is  the  most  impor- 
tant of  all  for  any  practical  application  of 
psychopathic  measures.  People  differ  so 
widely  that  the  same  course  cannot  be  pursued 
with  all.  It  is  true  that  most  of  the  patients 
who  come  to  us  in  need  of  these  remedies  ought 
to  have  to  some  extent  the  same,  or  nearly  the 
same,  management.  They  have  nearly  all  had 
too  many  cares  or  concerns  that  have  worried 
them  in  one  way  or  another.  These  need  to 
be  cut  down.  They  have  exhausted  the  power 
of  mental  attention  with  likes  and  dislikes. 
Their  irritability  has  become  phenomenal,  and 
their  nervous  equilibrium  has  reached  the  last 
limit  of  instability,  and  so  the  explosions  of 
hysteria  and  neurasthenia  come  easily.  This 
function  of  the  brain  requires  rest  and  sleep  to 
restore  to  their  normal  balance  the  brain  cells. 
And  the  mischievous  emotions  need  especially 
the  antidote  of  wholesome  indifference  long 
15 


MENTAL  THERAPEUTICS 

applied,  and  removed  as  far  as  possible  from 
the  causes  that  usually  set  them  in  motion. 
This  means  that  neurasthenic  men  should  get 
away  from  their  business  cares  that  nag,  and 
that  women  should  drop  every  social  obliga- 
tion and  the  demands  of  dress,  and  even  the 
care  of  their  homes  and  children  for  long  peri- 
ods, and  get  out  to  nature  and  a  little  way 
back  toward  barbarism. 

Many  of  them  have  worn  down  their  cerebral 
strength  by  anger  and  envy  and  jealousy,  and 
need  a  new  pasture  of  good  fellowship  and 
peace  with  the  world.  To  this  end  their  own 
families  may  need  to  be  made  over,  or  be  born 
again;  for  they  have  often  (of  course  unwit- 
tingly) helped  to  accentuate  every  fault  and 
defect.  Those  that  have  suffered  long  have 
suffered  more  as  the  days  have  passed.  Too 
much  attention  to  the  nerves  that  suffer  has 
exalted  their  capacity  to  cry  out.  All  such 
ought  to  be  taken  away  from  their  sensations 
by  some  powerful  influence  that  can  completely 
engage  the  mind  in  hope  and  attention,  and 
give  them  rest.  Some  of  these  people  need  to 
be  removed  for  a  time  from  the  irritating  pres- 
ence of  their  own  families — and  change  of 
place  and  scene  helps  most  of  them. 

Some  there  are  whose  power  of  objective 
attention  is  always  reduced  save  when  in  abso- 
lute health.  When  sick,  even  trivially,  the  sub- 
jective me  is  so  exalted  that  they  magnify  their 

16 


MENTAL  THERAPEUTICS 

symptoms  incessantly,  and  fence  themselves 
off  as  by  a  wall  from  the  objective  world.  As 
long  as  they  are  a  little  sick  nothing  will 
help  them  but  some  power  that  can  arouse  their 
faith  and  interest  to  rise  above  their  subjective 
trifles.  They  can  never  be  depended  on  very 
far,  even  when  well  and  able  to  forget  their 
sensations  and  live  an  objective  life  of  useful- 
ness ;  for  any  trifling  disorder,  fatigue  or  acci- 
dent unsettles  them.  They  are  unsafe  to  send 
on  long  campaigns ;  some  trifling  sensation  will 
make  them  retreat  in  a  hurry.  They  need  to 
be  dealt  with  carefully,  for  they  are  always 
lame  on  the  slightest  adverse  occasion.  And 
the  word  stoicism  is  not  in  their  vocabulary. 

Then,  those  with  an  abnormal  tendency  to 
psycho-neuroses  (the  hysterical  constitution) 
are  always  troublesome,  for  their  emotional 
natures  are  powder  magazines  ready  to  ex- 
plode if  they  are  merely  jiggled.  They  need 
the  same  dose  of  rest  from  their  usual  emo- 
tions, and  to  have  new  and  more  wholesome 
ones  introduced  into  their  lives.  They  are 
constantly  in  the  condition  of  a  normal  person 
who  has  been  nervously  overworked ;  their 
usual  state  is  one  of  neurasthenia  and  they 
should  be  so  managed,  and  large  nervous  tasks 
should  never  be  expected  of  them. 

They  require  more  nerve  rest,  and  more  pro- 
tection by  good  emotions  from  bad  ones  than 
their  fellows,  and  they  ought  to  be  spared  the 

17 


MENTAL  THERAPEUTICS 

severer  tests  of  common  life.  They  need  to 
travel  in  protected  paths  all  their  days.  More- 
over, many  such  need  a  service  that  is  rarely 
done  for  them,  namely,  to  be  shown  how  they 
are  constantly  living  with  emotions  that,  being 
of  the  wholesome  kind,  are  excessive  in  degree, 
or  with  those  that  are  altogether  wrong. 

Standing  in  the  way  of  this  service  is  a 
peculiar  secretiveness  as  to  their  emotional 
lives,  which  usually  prevents  their  nearest 
friends  from  ever  sounding  their  depths.  They 
themselves,  least  of  all,  know  and  can  study 
dispassionately  their  emotional  lives,  and  their 
own  families  and  fellows,  instead  of  helping, 
usually  aggravate  their  mental  warping. 

To  apply  the  right  remedy  in  each  case  suc- 
cessfully is  impossible.  The  most  we  should 
expect  is  partial  success,  for  the  mental  twists 
of  the  patients  are  so  varied,  as  well  as  the 
degrees  of  tact  we  can  use,  that  numerous 
misfits  must  occur.  Moreover,  it  will  be  said 
that  the  prescriptions  are  impossible;  that 
cares  and  worries  cannot  be  laid  aside ;  that  one 
cannot  forget  his  personal  griefs  and  mortifi- 
cations or  change  the  emotional  current  of  his 
life. 

But  there  are  thousands  of  people  who  have 
done  this  very  thing  when  absorbed  with  some 
new  thought  or  fad  or  faith;  and  some  have 
been  able  to  do  it  by  the  power  of  their  own 
common  sense  applied  to  themselves.  They  do 

18 


MENTAL  THERAPEUTICS 

not  put  aside  their  cares  and  griefs  so  much 
as  they  see  the  adjustment  of  them  to  the  rest 
of  the  universe,  and  discover  what  an  amount 
of  needless  worry  is  given  to  the  things  of  a 
day,  and  see  how  their  journeys  are  made  easier 
by  repressing  certain  emotions  and  encouraging 
others. 

Lack  of  wisdom  on  the  part  of  the  doctor 
causes  many  failures.  Tell  a  man  that  he  im- 
agines half  his  ills,  and  he  may  refuse  to  speak 
to  you  again.  But  tell  him  first  that  the  mind 
of  everyone  affects  the  body  always ;  then  that 
he  must  be  like  other  people;  then  ask  him 
seriously  to  think  if  it  is  not  possible  for  him 
to  be  dwelling  too  much  on  his  ailment — and 
you  have  perhaps  started  him  in  the  right  direc- 
tion willingly. 

To  a  few  it  is  safe  to  be  blunt  and  severe, 
and  to  tell  them  of  the  mental  element  in  their 
sickness,  but  it  is  rather  a  dangerous  experi- 
ment, so  fixed  are  sufferers  in  the  reality  of 
their  woes.  Any  hint  of  auto-exaltation  of 
woe  or  pain  is  generally  taken  as  proof  of  un- 
friendliness and  lack  of  sympathy.  When  such 
hints  are  taken  agreeably  the  benefit  is  prompt. 

Tell  a  man  that  his  fret  at  being  awake  keeps 
him  from  sleeping,  and  you  have  hardly  helped 
him  at  all.  But  show  him  how  an  honest  de- 
sire to  keep  awake  all  night  will  put  the  mind 
into  a  mood  of  such  tranquillity  that  the  spirit 
of  sleep  will  almost  certainly  come,  and  you 

19 


MENTAL  THERAPEUTICS 

have  removed  his  insomnia  and  transfigured 
his  soul.  Tell  a  woman  not  to  fret  at  the  ways 
and  foolishness  of  others,  and  you  are  talking 
to  the  sea;  but  show  her  how  these  annoying 
ways  are  inevitably  born  to  some  people,  and 
that  they  are  ethnic  curiosities  to  be  amused 
at,  and  you  have  done  her  a  service. 

It  is  easy  to  deal  with  the  patient  who  is  so 
sensible  that  he  can  change  his  mental  tenden- 
cies. You  have  only  to  show  him  that  his 
emotional  strain  and  his  nervous  agitation  are 
too  great,  and  he  becomes  tranquil  and  imper- 
turbable. But  such  people  are  the  rarest  ex- 
ceptions to  the  rule.  More  there  are  who  are 
so  constituted  that  they  must  have  some  mys- 
tery or  quality  of  the  unknowable  to  fix  their 
faith  on,  in  order  to  have  any  mental  benefit. 
It  is  difficult  to  deal  with  these  on  the  basis  of 
perfect  candor.  To  be  frank  and  unmyste- 
rious  is  to  fail  to  do  them  good.  Your  advice 
is  too  common  and  simple. 

Is  deception  justifiable  in  such  cases?  The 
answer  must  be  yes  and  no.  The  minds  of  the 
sick  are  many  times  distinctly  abnormal,  theo- 
retically we  cannot  regard  them  as  ever  quite 
normal;  and  they  are  not  capable  of  reasoning 
about  their  interests  exactly  like  themselves 
in  health.  But  many  are  at  times  more  capable 
than  the  average  of  well  people,  and  it  is  a  great 
problem  to  deal  with  each  of  them.  It  is  never 
right  to  be  unfair  to  the  best  interests  of  the 

20 


MENTAL  THERAPEUTICS 

sick.  But  it  is  not  unfair  to  leave  them  in  the 
dark  as  to  the  abstruse  things  of  cerebral  phys- 
iology that  nobody  understands  completely. 
The  plan  of  trying  to  explain  everything  to 
the  patient  has  its  drawbacks.  It  is  never  done 
anyway,  for  half  the  things  the  doctor  tries  to 
explain  he  only  partly  understands  himself, 
and  it  is  better  for  the  patient's  mind  in  most 
cases  to  be  either  dealt  with  dogmatically 
(usually  involving  a  degree  of  laudable  decep- 
tion because  the  doctor  pretends  to  know  some- 
thing he  does  not),  or  be  left  in  s~ome  admitted 
doubt  and  uncertainty.  This  latter  gives  room 
for  faith,  which  is  wholesome. 

Where  the  psychological  element  is  strong 
we  do  wrong  not  to  try  to  create  faith  and  hope 
that  may  help.  Whether  this  is  done  by  the 
positiveness  of  the  doctor  or  by  something 
else  matters  little,  as  long  as  it  is  done.  If 
religion  can  make  one  happy  and  hopeful,  it  is 
one  of  the  natural  rights  of  the  sick  man  to 
have  it;  and  if  something  that  stands  for  it 
can  in  any  way  relieve  cares  and  give  rest  of 
soul  (which  means  emotional  rest),  it  must 
not  be  withheld.  No  physician  can  justify  his 
neglect  of  psychologic  influences  that  give  hope, 
on  the  ground  of  his  efforts  to  be  strictly 
scientific,  when  he  considers  his  own  shortcom- 
ings in  every  sort  of  knowledge. 

A  patient  who  has  perhaps  suffered  long  or 
who  is  impatient,  asks  for  his  doctor's  views 

21 


MENTAL  THERAPEUTICS 

about  some  one  of  the  insubstantial  cults,  and 
the  doctor  is  troubled  to  know  what  he  shall 
reply  that  will  comport  with  his  duty  to  be  help- 
ful to  the  sick,  and  not  strain  his  common  sense 
or  self-respect.  His  temptation  is  to  say  that 
it  is  all  nonsense;  that  only  weak-minded 
people  take  it  up ;  that  any  good  effects  from  it 
are  imaginary ;  and  that  it  tends  toward  mental 
unbalancing.  Each  of  these  declarations 
expresses  a  partial  truth,  yet  they  should  not  be 
said  to  the  patient.  To  say  them  might  con- 
structively discredit  a  number  of  other  reli- 
gious beliefs,  some  of  which  the  doctor  himself 
may  have  great  respect  for.  Besides,  they  do 
not  express  the  exact  truth. 

The  time  comes  in  the  mental  experience  of 
some  people  when  they  are  tired  of  thinking 
(if  they  do  think)  and  depending  upon  the 
science  of  things  that  is  the  common  knowledge 
of  the  world.  They  seem  to  need  something 
novel  that  does  not  require  thinking,  only 
believing.  And  sometimes  the  most  unrea- 
sonable thing  takes  the  best;  the  greater  the 
jump  from  a  basis  of  reason  into  chaos,  the 
easier  it  is  for  some  people  to  make  it.  Ought 
physicians  wholly  to  discourage  such  things 
because  the  concepts  believed  are  unscientific 
and  absurd  ?  This  seems  natural,  but  we  must 
remember  that  the  parts  of  all  religions  which 
people  take  on  faith  are  inexplicable  by  any  of 
our  scientific  formulas.  Moreover  nearly  all 
22 


MENTAL  THERAPEUTICS 

scientific  men  have  had  some  religious  beliefs 
no  more  justified  on  logical  grounds  than  the 
non-existence  of  matter,  or  some  of  the  equally 
absurd  theories  of  our  friends  whose  sanity 
we  are  tempted  to  impeach.  And  it  is  a 
psychologic  fact  that  somehow  such  unreason- 
ing faith  helps  to  tranquillity  of  soul,  and  tends 
rather  to  good  conduct  among  men,  and  this  is 
one  of  the  several  compensations. 

Why  not  be  entirely  truthful  as  well  as  can- 
did with  such  inquiring  people?  We  might 
then  say  this,  and  say  it  kindly:  If  you  have 
reached  a  point  where  you  must  have  something 
more  than  you  now  possess  to  pin  your  faith  to, 
this  new  doctrine  may  serve.  If  you  cannot 
make  a  haven  of  mental  rest  along  the  well- 
known  laws  of  brain  action  but  must  have 
something  occult  or  mysterious  to  lean  upon, 
this  new  belief  may  help.  If  you  are  ready  to 
deny  the  laws  of  nature  as  to  your  own  body, 
while  you  rely  on  them  in  your  business  and 
money-making,  this  new  thing  is  probably 
what  you  are  looking  for.  If  you  can  put 
aside  your  scruples  about  the  common  knowl- 
edge of  all  time,  and  cease  to  stickle  for  it, 
and  give  yourself  unreasoningly  to  this  new 
doctrine,  it  will  probably  give  you  mental  com- 
fort. Then  the  ridicule  of  the  world  of  science 
that  insists  on  the  existence  of  matter,  as  well 
as  that  of  the  believers  in  the  older  religions 
will,  by  its  very  boon  of  martyrdom,  make  it 

23 


206662 


MENTAL  THERAPEUTICS 

easier  for  you  to  believe  and  bear  it  all  with 
sweet  temper. 

The  cerebral  wear  and  tear  of  our  extreme 
civilization  leads  to  many  cases  of  neuras- 
thenia and  general  uselessness,  and  to  many 
sorts  of  hysteria  and  insanity.  The  medical 
profession  and  all  thoughtful  people  alike 
ought  to  do  something  to  lessen  this  for  the 
hampered  people  who  go  about  their  business 
from  day  to  day,  and  try  to  keep  well,  or  pre- 
tend they  are  well.  This  service  may,  I 
believe,  be  done  if  we  will  study  the  subject 
with  something  of  the  enthusiasm  with  which 
we  have  pursued  the  microbes,  and  not  ignore 
the  influences  that  are  wholly  mental. 

It  is  evident  that  the  remedy  lies  either  in 
the  direction  of  lessening  the  load  or  increasing 
the  cerebral  capacity  to  bear  it.  There  is  small 
chance  of  increasing  the  power ;  a  thousand 
years  hence  this  may  come  to  be  done,  perhaps 
by  the  process  of  development  and  the  survival 
of  the  fittest  through  the  centuries.  At  present 
the  power  of  mental  endurance,  other  things 
being  equal,  is  substantially  fixed  for  every 
person.  It  may  be  increased  by  various  aids 
for  brief  periods  only.  As  other  things  are 
usually  unequal  it  can  generally  be  more  econo- 
mically used  than  it  is,  and  this,  for  the  better 
business  of  life,  is  tantamount  to  increasing  it 
somewhat.  To  lighten  the  load  should  be  our 
aim,  for  the  load  is  too  heavy  now,  especially 
24 


MENTAL  THERAPEUTICS 

in  the  refined  and  forceful  society  of  America. 

How  to  do  this  is  the  problem.  It  is  easy 
to  say  we  will  begin  by  cultivating  the  better 
emotions  and  reducing  the  wearing  ones,  and 
by  cutting  down  the  needless  burdens.  But 
we  have  religions  and  ethics  and  philosophy, 
and  through  the  centuries  have  been  taught  to 
keep  the  good  emotions  and  discard  the  bad 
ones,  and  to  put  away  foolishness.  And,  not- 
withstanding all  our  good  precepts  and  some 
good  examples,  we  have  got  into  the  bad  ways 
of  the  present  time.  We  must,  evidently,  be 
more  specific  as  well  as  more  radical  in  our 
measures.  If  any  great  good  is  done  the 
remedies  must  be  fundamental,  and  far-reach- 
ing in  their  effects;  not  a  few  must  be 
influenced,  but  many,  or  no  improvement  will 
come  to  the  community  as  a  whole.  But  we 
ought  to  help  the  few,  if  we  cannot  reach  the 
multitude. 

A  certain  few  cardinal  things  are  apparently 
necessary  to  be  done  in  the  care  and  culture  of 
the  people,  and  they  are  mental  and  moral 
mostly. 

1.  We  must  lessen  the  emotional  attentions 
to  infants.  These  wear  out  the  brain  energy 
and  produce  erethism  that  may  last  through 
life.  Almost  any  infant  can,  in  three  months, 
be  developed  into  an  autocrat,  attempting  to 
rule  his  world ;  and  many  of  them  have,  before 
25 


MENTAL  THERAPEUTICS 

the  end  of  their  first  year,  true  neurasthenia 
resulting  from  these  influences. 

2.  As  far  as  possible  we  ought  to  let  the 
children  severely  alone,  and  stop  the  common 
incessant  effort  to  entertain  them.  This  effort 
continues  the  harmful  effect  of  too  much  emo- 
tional attention  in  infancy.  Let  them  enter- 
tain themselves;  this  will  develop  their  minds 
and  rest  their  emotions.  We  ought  to  observe 
them,  with  their  knowledge,  and  talk  about 
them  in  their  presence  less.  We  do  this  now 
so  much  as  to  provoke  a  series  of  most  vicious 
emotions  that  grow  into  bad  life  habits.  Fairy 
tales  and  fairy  talk  are  unwholesome  to  most 
of  them.  The  average  child  already  has  too 
much  imagination ;  it  is  a  beautiful  thing  but  it 
is  not  necessary  to  increase  it. 

Such  rules  for  infants  and  children  en- 
counter many  difficulties.  Two  motives 
actuate  parents  and  children  alike.  The 
first  is  to  see  that  the  children  are  happy  and 
pleased  here  and  now.  The  reflex  effect  on 
their  elders  is  pleasant ;  we  like  a  happy  child, 
and  like  to  make  a  child  happy.  Thus  we  and 
the  child  conspire  to  the  same  end.  The 
second  motive  is  to  make  sure  that,  if  possible, 
the  career  of  the  child  shall  be  long  and  success- 
ful. Both  emotions  are  for  the  good  of  the  ris- 
ing life  as  we  understand  it,  the  one  for  the 
now,  and  the  other  for  the  future.  Is  it  any 
wonder  that  we  should  generally  sacrifice  the 

26 


MENTAL  THERAPEUTICS 

future  for  the  present  ?  The  child  is  incapable 
of  foregoing  a  present  pleasure  for  a  future 
good,  and  the  parents  are  too  ready  to  agree  not 
to  count  this  day's  indulgence,  even  when  they 
know  its  ulterior  effect  is  bad.  A  mother  car- 
ries her  baby  in  her  arms  a  long  time  to  get  it 
to  sleep  because  it  likes  to  be  carried  and 
refuses  to  go  to  sleep  in  its  bed.  She  says  the 
child  will  not  go  to  sleep  otherwise,  but  if  she 
reflects  she  knows  this  to  be  a  tender-hearted 
fiction.  Her  fault  is  lack  of  courage  to  break 
the  habit.  As  the  child  grows  older  and  begins 
to  acquire  ways  that  she  fears  may  make  him 
inelegant  or  impolite  she  has  no  hesitation  in 
working  for  his  future,  and  she  will  drill  him 
by  the  hour  and  worry  by  the  day  about  his 
manners  (that  at  fifteen  he  would  spon- 
taneously correct),  and  let  him  go  on  with  ner- 
vous injuries  that  will  last  him  through  life. 
Parents  are  shocked  if  their  boys  smoke  cigar- 
ettes, but  they  have  allowed  habits  of  the  ner- 
vous system  from  babyhood  up  that  are  even 
worse  for  the  future  of  a  boy  than  smoking 
cigarettes  in  his  teens.  Parents  who  have  per- 
petually entertained,  coddled,  and  diverted  their 
children,  who  have  jumped  to  their  call  as  to 
the  command  of  a  superior  being,  are  logically 
estopped  from  objecting  to  cigarettes,  coffee, 
wine  or  late  hours,  when  the  children  pass  into 
youth,  and  would  still  gratify  their  desires  for 
all  sorts  of  stimulating  amusements.  None  of 

27 


MENTAL  THERAPEUTICS 

these  sins  against  nature  is  so  great  as  those 
that  have  been  earlier  fostered  and  encouraged. 
Indeed,  had  the  earlier  ones  never  been  com- 
mitted, many  of  these  later  indulgences  would 
not  be  sought.  The  exaltation  of  nerve  centers, 
born  of  vicious  excitement  in  childhood  and 
continued  in  years  of  habits,  cannot  be  ignored 
in  later  life. 

Parents  plead  that  their  children  ought  to 
be  obedient  and  self-denying  as  to  indulgences 
that  harm,  because  they,  the  parents,  have  been 
good  to  them  in  their  infancy  and  childhood, 
have  devised  pleasures  for  them,  and  denied 
them  little  or  nothing  of  joy.  This  is  the  very 
gist  of  the  error.  If  the  emotional  propensities 
of  the  children  had  received  as  much  tranquil 
rest  as  their  muscles,  their  brains  would  have 
grown  up  with  more  normal  demands  and  with 
better  resisting  power. 

3.  We  ought  to  stop  making  young  ladies 
and  gentlemen  out  of  children.  To  push  them 
into  responsible  social  life,  as  early  as  is  the 
rule  in  the  best  social  strata,  is  to  develop  emo- 
tions and  cares,  and  subject  them  to  tests  and 
temptations  that  ought  to  be  postponed  for 
years.  And  the  only  justification  we  have  for 
it  is  our  and  their  unwholesome  pleasure  in  it 
all,  and  their  hoped-for  escape  from  embarrass- 
ing diffidence  later.  The  truth  is  that  for  many 
of  them  the  diffidence  is  an  advantage,  and 
ought  to  be  encouraged  rather  than  otherwise. 

28 


MENTAL  THERAPEUTICS 

4.  We    ought    to    decrease    the    emotional 
struggles  at  school  as  far  as  possible.     The 
strife  for  supremacy,  the  fear  of  failure,  the 
envy  and  jealousy  of  others,  constitute  one  of 
the  most  wearing  influences  on  the  brains  of 
the  young.*     Not  all,  by  any  means,  but  many 
of  the  school  children  suffer  in  this  way.    It  is 
a  duty  to  find  out  the  ones  being  most  harmed, 
and  protect  their  nervous  lives  if  possible. 

5.  An  increase  of  the  outdoor  athletic  life  of 
the  people  as  a  whole  would  be  one  of  the  great- 
est gains  of  all.    Indoor  life  keeps  us  below  the 
par  physiologic,  and  to  raise  the  vigor  of  the 
system  as  a  whole  of  course  helps  the  brain. 

6.  To  reduce  and  repress  the  unhappy  emo- 
tions that  are  engendered  by  the  struggle  to 
shine  in  society  and  in  business,  is  one  of  the 
most  urgent  needs,  and  hardest  services  to  ren- 
der.    These  emotions  are  envy,  jealousy,  fear 
of  failure,  and  sense  of  danger  to  our  pride,  all 
of  which  are  wearing  and  depressing.    This  is 
the  school  experience  carried  into  adult  life; 
and  with  all  its  ramifications  it  does  incalcul- 
able harm  to  the  cerebral  resisting  power.    To 
reduce  the  struggle  itself  as  well  as  its  bad 
emotions  is  quite  as  important.    This  ardor  to 
do  the  duties  that  society  and  business  seem 
to  impose  on  us   (and  beyond  the  getting  of 
bread)    is  a  large  part  of  the  cause  of  the 

*The    humiliation    of   failure    in    a    school    examination    has 
driven    many    a    fine   boy    to    suicide. 

29 


MENTAL  THERAPEUTICS 

nervous  overwork  among  men  and  women. 
When  a  woman  has  neurasthenia  from  nervous 
overdoing,  the  chances  are  six  in  ten  that  the 
excess  of  work  was  done  in  response  to  a 
demand  of  some  sort  of  social  tyranny,  and  was 
thus  by  the  highest  ethics  unnecessary.  The 
same  truth  obtains  with  men  only  to  a  slightly 
lesser  degree. 

7.  Less  dress-parade  in  our  lives  is  neces- 
sary.     Reduce   the   everlasting   dressing   and 
parading  of  our  persons,  houses,  tables  and 
equipages !     It  all  becomes  a  bug-bear  to  the 
tired-out  brain,  and  it  tires  the  brain.     It  is 
what  makes  women  feel  like  going  crazy  when 
they  think  of  packing  their  trunks  for  a  trip 
to  a  fashionable  resort,  and  it  makes  some  of 
them    really   crazy.      Such    parade    is    a    silly 
demand  that  our  conceit  and  envy  make  upon 
us,  to  the  worry  of  the  tired  brains,  and  with 
the  paltriest  return  in  life's  recompenses. 

8.  It  is  merely  a  truism  to  say  that  people 
who  are  carrying  mind  and  body  loads  that 
are  too  heavy  should  have  them  lightened.    If 
the  load  is  apparently  necessary  and  free  from 
the  vice  of  bad  emotions,  the  rest  is  as  truly 
necessary.     Rest  and   change  are   demanded. 
These  influences  shift  the  bearings ;  take  off  the 
pressure  from  parts  and  powers  that  are  tired, 
and  put  into  exercise  faculties  that  have  been 
dormant,  so  that  the  man  as  a  whole  is  helped, 

30 


MENTAL  THERAPEUTICS 

his  brain  and  body  are  refreshed,  and  mental 
wreck  is  fought  off. 

The  influences  here  condemned  are  what  in 
large  measure  make  the  apparently  inevitable 
revolutions  of  the  wheel  of  American  society. 
It  is  a  spectacle  that  the  old  world  has  fur- 
nished, only  in  a  different  degree,  again  and 
again.  Many  eminent  and  resourceful  families 
eventually  fall  behind  in  the  greater  world 
influences,  while  their  places  are  taken  by 
people  who  have  come  up  from  humbler  begin- 
nings. The  rise  to  power  of  these  is  due  to 
the  fact  that  they  have  suffered  less  injury 
from  the  emotions  that  grind  and  wear  out  the 
nerve  force.  They  have  lived  simpler  lives 
nearer  to  nature,  and  have  been  moved  by 
ambitions  that  are  less  carking  and  unwhole- 
some. 

This  continual  revolution  of  the  wheel  is  self- 
acting  and  wholly  conservative  for  mankind. 
The  race  and  group  fit  to  command,  in  the  long 
run,  usually  come  up  to  power.  The  lessening 
of  grasp  due  to  the  dissipations  incident  to  the 
use  and  abuse  of  power — the  miscalled  rewards 
of  power — causes  its  victims  to  drop  behind  in 
the  struggle  and  give  place  to  those  not  handi- 
capped by  such  influences.  And  the  wheel 
promises  to  go  on  revolving  as,  and  wherever, 
this  debauchery  of  resources  occurs,  and 
nobody  can  deny  that  the  struggle  is  fair,  and 
the  verdict  world-wise. 
31 


The  Economic  Waste  of  Sickness 
and  Premature  Death 


The  Economic  Waste  of  Sickness 
and  Premature  Death* 


Throughout  our  years,  from  youth  to  age, 
we  are  individually  prone  to  miscalculate  the 
economies  of  our  lives.  We  have  aspirations 
and  ambitions.  We  would  get  on  in  the  world. 
We  can  earn  so  much.  It  will  cost  so  much 
for  food  and  shelter,  for  clothes  and  warmth, 
for  schooling  and  for  luxuries.  We  must  have 
certain  embellishments.  A  watch  is  an  orna- 
ment and  will  usefully  mark  the  time — it  will 
cost  one,  or  a  hundred  dollars.  And  we  must 
have  fine  clothes  and  feathers  and  jewels,  and 
amusements — we  must  play  as  well  as  work. 
Will  our  earnings  compass  all  these? 

Our  calculations  are  based  on  the  theory 
that  these  are  all  the  elements,  and  that  we 
shall  continue  to  be  here  and  able  to  work.  We 
do  not  allow  that  perhaps  we  may  fall  sick, 
and  find  all  our  plans  go  wrong.  So  we 
provide  no  surplusage. 

But  we  know  that  the  pianist  who  loses  a 


•Delivered  at  the  Central  Presbyterian  Church  of  Rochester, 
N.  Y.,  on  the  occasion  of  the  meeting  of  the  American  Public 
Health  Association  and  the  annual  conference  of  the  Sanitary 
Officers  of  the  State  of  New  York,  September  8,  1915. 

35 


THE  ECONOMIC  WASTE 

finger  must  change  his  occupation.  We  know 
that  the  chief  oarsman  who  has  the  colic,  or 
has  eaten  or  drank  too  much,  loses  the  race. 
To  the  engineman  a  spell  of  dizziness  may 
cause  a  collision  of  trains;  and  the  fame  of  a 
general,  and  the  issue  of  a  battle,  may  be  lost 
by  an  attack  of  headache. 

The  problem  is  the  same  for  every  child. 
The  career  of  your  boy  is  at  the  mercy  of  your 
neighbor's  boy  who  plays  with  him,  and  who 
has  a  throat  diphtheria.  Your  boy  is  at  the 
mercy  of  a  slight  blow  on  the  back  or  the  hip, 
which  may  disable  him  with  joint  tuberculosis, 
and  make  him  a  dependent  for  life  instead  of  a 
power  in  the  world.  Or  he  may  have  an 
infected  lung,  or  pleura,  that  knocks  all  your 
calculations  awry ;  that  transforms  him  from 
one  who  would  lift  to  one  who  must  lean  all 
his  life. 

In  planning  our  own  and  our  children's  lives 
we  usually  fail  to  make  any  calculation  that 
health  may  break  down,  and  that  the  individual 
may  become  a  liability  instead  of  an  asset  to 
his  family  and  the  community.  If  we  could  be 
compelled  always  to  consider  this  vital  interest, 
it  would  amount  to  the  greatest  single  reform 
in  society,  for  it  would  keep  us  and  our  children 
away  from  many  of  the  pitfalls  of  physical 
calamity.  The  economics  of  health,  sickness 
and  premature  death  are  at  once  the  most 

36 


OF  SICKNESS 

needed  and  most  neglected  subjects  of  our 
study. 

We  covet  good  health  because  it  means 
longer  life,  which  is  the  world's  desire,  and 
the  first  impulse  of  the  normal  human  heart. 
Good  health  makes  us  forget  the  terrors  of 
death.  Pain  and  suffering,  doubtless,  are 
great  discipline  for  us,  but  we  always  hate 
them  and  always  must.  Sickness  handicaps 
us  and  blights  our  prospects  and  hopes  for 
the  joys  we  think  we  are  entitled  to.  So  in 
our  quiet,  sane  moments  we  are  ashamed  of 
such  of  our  foibles  and  our  sins  as  bring  on 
sickness;  for  this  reason  we  try,  some  of  the 
time,  to  lop  off  these  and  to  keep  well. 

Less  often  do  we  consider  the  economic 
reasons  for  trying  to  keep  well,  yet  they  are 
among  the  most  vital  reasons  of  all.  We  not 
only  neglect  the  calculation,  we  are  often  a 
little  ashamed  to  broach  the  subject  when  it 
involves  our  friends  and  our  families ;  it  seems 
mercenary  and  ignoble.  A  man  will  warn  his 
son  to  avoid  carelessness  and  foolishness  that 
might  make  him  sick  or  handicap  him  for  life; 
he  will  say,  "If  you  get  sick  you'll  have  to  go 
to  bed,  take  disagreeable  medicine,  and  be 
kept  from  pleasures — and  you  might  die."  He 
may  warn  the  youth  that  if  he  gets  sick  his 
mother  must  nurse  him,  and  that  may  make  her 
sick,  but  not  a  word  about  the  inability  of  the 
family  to  bear  the  expense  of  sickness.  Yet 

37 


THE  ECONOMIC  WASTE 

this  may  be  the  chief  reason.  Unable  to 
afford  a  nurse,  the  mother  nurses  the  family 
invalids  and  becomes  one  of  them  herself. 

In  an  active  practice  of  medicine  of  several 
decades,  and  having  some  familiarity  with  the 
life  of  many  hundreds  of  families,  I  recall 
hardly  an  instance  among  lay  people  in  which 
the  caution  for  health's  sake  was  frankly  urged 
on  economic  grounds.  And  when  it  has  been 
so  urged  it  has  usually  been  spoken  of  under 
the  breath,  as  though  it  were  a  shame  to  put 
life  and  health  on  so  sordid  a  basis. 

But  the  economic  basis  is  a  most  vital  one, 
and  money  is  our  call  on  the  world  for  the 
munitions  that  fight  off  sickness  and  death; 
for  it  is  a  fight,  and  a  continuing  one,  till  death 
takes  us.  Comfort,  health,  refuge  from  sick- 
ness and  death,  are  often  found  by  means  of 
this  potent  thing  called  money. 

Sickness  and  early  death  are  the  greatest 
drains  on  the  resources  of  most  of  us — and 
more  than  any  one  influence  handicap  us, 
personally  and  in  families,  in  our  search  for 
the  things  of  life  that  are  of  paramount  value. 
Sickness  is  our  greatest  pauperizer,  as  health 
is  our  greatest  asset;  and  we  usually  ignore 
both  of  these  truths. 

The  actuaries  have  made  it  easy  for  us  to 
state,  with  some  approach  to  accuracy,  the 
money  value  of  health,  the  loss  to  the 
community  from  sickness  through  loss  of 

38 


OF  SICKNESS 

earning  time  and  from  the  expense  that  must  be 
paid  in  cash.  They  have  also  shown  us  the 
vast  public  loss  from  child  mortality.  Not 
only  is  all  sickness  expensive,  but  epidemics 
have  destroyed  nations  and  peoples,  have  led 
to  the  defeat  of  armies,  and  have  interrupted 
and  postponed  for  centuries  great  public  works 
that  have  been  needed  in  the  development  of 
society  and  the  safety  of  states.  The  Panama 
Canal  is  one  of  these. 

There  can  be  no  doubt  that  the  figures  are 
fairly  correct  as  to  the  ultimate  cost  and  the 
loss  to  the  individual  and  the  public  from 
these  calamities,  but  the  loss  appears  to  be 
largely  in  the  cutting  off  of  possible  future 
gains  rather  than  from  loss  of  so  much  cash 
out  of  pocket  (except  sickness  expense)  ;  and 
so  the  public  is  slow  to  believe  wholeheartedly 
in  the  figures. 

The  pecuniary  worth,  potential  and  pros- 
pective, of  an  individual  at  different  ages  is 
given  by  Fisher  as  follows: 

At  birth   $     90 

At    5  years 950 

At  10  years 2,000 

At  20  years 4,000 

At  30  years 4,100 

At  40  years 2,900 

At  80  years  minus 700 

The  value  of  life  is  figured  on  the  possible 
earning  power  through  the  years  that  are 
promised  for  the  individual,  so  the  value  of 

39 


THE  ECONOMIC  WASTE 

the  younger  members  is  high;  that  of  middle 
life  is  a  diminishing  amount;  while  the  aged 
have  less  than  nothing  of  value  in  this  sort. 

The  annual  cost  of  illness  and  death  in  the 
United  States  is  conservatively  placed  at 
$460,000,000 ;  let  us  add  $500,000,000  for  loss 
of  earnings  by  the  victims,  and  we  have  a  total 
of  $960,000,000. 

According  to  the  most  thorough  survey  of 
Pittsburgh,  covering  the  experience  of  typhoid 
fever  for  thirty-five  years,  Mr.  F.  E.  Wing 
found  that  the  cases  lasted  in  disability  an 
average  of  over  thirty-four  days,  and  that  the 
cost  to  the  community  of  each  death  was 
$6,000.1  In  four  years  the  cost  on  this  basis 
was  $9,000,000.  In  October,  1907,  before  the 
filtration  plant  for  the  city  water  was  finished, 
there  were  593  cases.  In  October,  1908,  after 
the  plant  was  in  use,  there  were  ninety-six 
cases.  Assuming  that  the  497  cases  shown  to 
be  avoidable  suffered  a  mortality  of  10  per 
cent.,  which  is  a  fair  estimate,  there  were  forty- 
nine  deaths  in  one  month,  costing  the  com- 
munity $294,000.  At  this  rate  the  saving  to 
the  public  would  cover  the  cost  of  the  filtration 
plant  in  nineteen  months. 

The  loss  by  preventable  or  postponable 
deaths,  the  country  over,  is  probably  many 


JIrving  Fisher  gave  to  the  International  Congress  on 
Tuberculosis  the  actual  cost  of  each  death  by  tuberculosis 
as  $8,000. 

40 


OF  SICKNESS 

million  dollars  yearly.  Fisher,  some  years 
ago,  figured  out  the  economic  saving  through- 
out the  country,  if  needless  sickness,  deaths  and 
fatigue  could  be  prevented,  as  1,500  millions 
of  dollars  annually.  Nobody  knows,  or  can 
know  exactly,  what  proportion  of  deaths  are 
preventable  or  postponable,  but  every  student 
of  the  subject  is  sure  that  a  very  large  pro- 
portion are  preventable — or  rather  are  capable 
of  being  postponed  to  a  later  time  of  life. 
Especially  is  this  true  of  the  deaths  of  infants 
and  children.  Much  of  the  average  increase 
of  the  span  of  life  among  enlightened  peoples, 
from  about  33  to  45  or  more  years,  has  unques- 
tionably been  due  to  the  saving  of  child  lives. 

For  a  long  time  evidence  has  been  accumu- 
lating that  the  average  life  is  growing  longer. 
Two  hundred  years  ago  the  gain  was  4  or  5 
years  in  a  century;  one  hundred  years  ago  it 
was  nearly  10  years  per  century;  now  it  is  at 
least  50  per  cent,  more  than  this,  or  in  excess 
of  15  years  per  century,  in  this  country.1 

We  may  postulate,  and  we  ought  to  assert, 
that  the  great  purpose  of  public  effort  should 
be  to  make  the  world  a  better  place  to  live  in. 
That  is  a  broad,  simple,  general  proposition  that 
is  understandable.  It  is  axiomatic. 

What  constitutes  making  the  community  a 
better  place  to  live  in?  What  must  every 


1  The   mortality    in    Chicago    in    1921    was    eleven    (11)    per 
1,000  of  the  total  population. 

41 


THE  ECONOMIC  WASTE 

community  do  to  this  end  ?  Many  things  may 
be  necessary,  and  they  will  vary  with  local 
conditions,  but  they  all  tend  and  must  tend  in 
the  final  analysis  to  one  aim,  and  that  is  the 
prolongation  of  the  average  human  life.  If 
human  life  is  growing  shorter,  the  world  is  a 
worse  place;  if  growing  longer,  it  is  a  better 
place. 

The  shortening  of  the  average  means  more 
deaths  in  early  years;  lengthening  it  means 
fewer  child  deaths  and  more  people  reaching 
adult  and  advanced  age;  more  people  spared 
for  the  productive  years  of  life.  Longevity  is 
fostered  in  all  ages  by  good  health  and  free- 
dom from  accidents  and  infections.  These  con- 
ditions connote  longevity  and  the  cutting  out 
of  the  money  losses  of  sickness,  disablement, 
and  death  of  prospective  bread  winners,  other- 
wise the  children. 

With  increase  in  average  longevity  the  race 
is  maintained  numerically  by  a  lower  birth 
rate,  and  this  invariably  follows.  A  lower 
average  birth  rate  means  more  vigorous 
mothers ;  fewer  women  destroyed  in  early  life 
by  excessive  child  bearing.  Other  things  being 
equal,  smaller  families  mean  more  vigorous 
children.  High  death  rate  among  children 
means  high  birth  rate.  This  usually  means 
poverty,  and  may  mean  degradation.  The 
child-bearing  adults  are  sometimes  so  depressed 
in  body  and  spirit  by  hard  labor,  by  sickness 
and  death  about  them,  that  all  their  higher 
42 


OF  SICKNESS 

ambitions  are  destroyed;  and  this  is  degrada- 
tion. 

A  late  review1  quotes  some  very  meaningful 
statistics  on  this  subject  which,  while  possibly 
not  entirely  accurate  for  all  of  the  countries 
considered,  are  doubtless  comparatively  cor- 
rect. It  says  that  of  21  countries,  outside 
of  America,  11  have  an  average  longevity  of 
over  50  years;  the  other  10  under  50  years. 
The  11  have  an  average  birth  rate  of  24.9 
annually  per  thousand  people,  and  a  death 
rate  of  14.08.  The  10  have  analogous  figures 
of  36.2  and  22.5.  Russia  has  the  highest  birth 
and  death  rate — 45  and  28.3  respectively,  with 
a  longevity  of  only  27.8  years,  and  an  annual 
increase  in  population  of  16.7  per  cent.  On 
the  other  hand,  Australia  has  very  low  birth 
and  death  rates,  and  the  highest  longevity.  The 
rates  are  birth  27.5,  death  10.8,  longevity  56, 
and  natural  increase  16.7 — exactly  the  same 
as  Russia.  The  writer  compares  Austria- 
Hungary  with  Great  Britain.  The  former  has 
a  birth  rate  of  31.7,  death  rate  21.2,  longevity 
38.3  years,  and  annual  increase  of  10.5  per 
cent. ;  while  the  figures  for  Great  Britain  are 
birth  24.4,  death  14.2,  longevity  53.8,  and 
annual  increase  10.2  per  cent.  The  increase 
being  so  similar  in  the  countries  compared 
with  each  other,  he  infers  some  natural  law 
maintaining  a  fixed  relation  of  births  to  the 

'Editorial,    North    American    Review,    August,    1915. 

43 


THE  ECONOMIC  WASTE 

deaths  in  a  community.  It  is  a  logical  con- 
clusion, but  the  law  is  in  part  physiologic. 
It  is  not  wholly  some  recondite  "law"  of 
unaided  nature  that  lessens  the  births  as  the 
death  rate  falls.  Other  causes  are  a  wide- 
spread reduction  of  marriages,  especially  of 
early  ones,  and  a  more  or  less  extensive  resort 
to  methods  of  limiting  the  size  of  families. 
Under  our  laws  it  is  a  crime  to  teach  such 
methods  to  others,  but  whether  or  not  it  is 
wicked,  or  how  wicked  soever  it  is,  the  prac- 
tical fact  is  that  some  people  discover  methods 
and  resort  to  them. 

As  people  prosper,  are  more  effective,  live 
longer,  become  rich,  educated  and  refined,  the 
death  rate  decreases ;  so  does  the  birth  rate. 
Large  families  come  to  the  few  among  this 
class  who  covet  them,  or  believe  on  religious 
grounds  that  they  ought  to  have  them ;  but 
mainly  they  come  to  the  poor,  simple,  unedu- 
cated, natural  folk  who  love  children  and  be- 
lieve that  God  sends  them,  and  these  people  are 
the  stalwart  ones  who  are  forever  rising  in  the 
scale  of  world  values,  and  are  becoming  the 
controlling  factors  of  society.  This  class 
itself  degenerates  later;  and  their  descendants 
give  place  finally  to  like  people  as  they  were  at 
the  beginning,  and  so  the  wheel  revolves. 

With  such  percentages  of  annual  increase  in 
population  as  have  been  noted,  the  nations  will 
some  day  reach  the  limit  of  convenient 

44 


OF  SICKNESS 

existence.  Famine,  pestilence  and  war  have, 
in  the  ages  past,  kept  the  race  numerically 
within  living  bounds.  With  world  fellowship 
and  means  of  transportation  increasing,  and 
the  increase  of  land  production  due  to 
improved  agriculture,  famines  will  decrease; 
with  pestilential  epidemics  coming  steadily 
under  more  control  with  a  promise  of  sup- 
pression of  most  of  them,  the  sweeping 
mortality  of  plagues  is  becoming  less  common. 
When  the  combined  food  products  of  the  earth 
are  insufficient  for  the  mouths  that  are  to  be 
fed,  what  will  happen? 

Speculation  may  be  unprofitable,  but  it  is  a 
safe  guess  that  the  diminishing  birth  rate  will, 
so  far  from  destroying  the  race,  actually  save 
it  in  such  circumstances.  Nor  will  the  pro- 
gressive reduction  of  births  endanger  the 
existence  of  the  race.  With  the  refinements 
and  luxury  of  the  many  who  will  live  in  that 
far-off  time,  there  will  always  be  more  of  the 
humble,  simple,  clean  and  physically  strong 
people  who  will  preserve  the  race  from  de- 
struction, until  the  approach  of  the  end  of  the 
habitable  life  of  the  earth.  That  will  be 
millions  of  years  in  the  future,  and  I  believe 
that  even  then  the  human  race  will  pro- 
gressively adjust  itself  to  the  oncoming  severe 
conditions,  and  live  ages  after  we  short-sighted 
people  would  naturally  guess  that  the  last  man 
must  die. 

45 


THE  ECONOMIC  WASTE 

With  increased  longevity,  life  is  easier,  and 
easier  because  of  it.  Life  for  all  the  people 
can  be  easier  only  by  reason  of  more  substance, 
that  is,  less  useless  expense,  less  waste  of 
energy.  This  means  stable  governments,  stable 
and  fixed  conditions  of  living,  continued 
through  many  generations;  good  public  and 
personal  hygiene  long  continued;  constant 
watchfulness  to  guard  against  dangers  of  all 
sorts.  It  means  in  general,  peace  and  plenty. 
Longevity  is  increased  by  conservation  of  the 
powers  of  the  individual,  and  the  lessening  of 
forced  hard  work  for  long  periods,  especially 
by  women  and  children.  It  is  increased  by 
regular,  moderate  work,  and  by  wholesome 
attention,  not  with  soul-breaking  intensity,  to 
all  the  serious  problems  of  life.  But  too  much 
luxury  and  idleness  tend  to  rather  early 
degeneration  of  the  tissues  of  the  body,  and 
so  a  shortening  of  the  average  longevity. 

Moral  suasion  will  probably  never  produce 
the  greatest  progress  for  the  betterment  of 
mankind  through  improved  health  conditions. 
Nor  will  the  good  example  of  the  small  minor- 
ity of  excellent  people  who  lead  hygienic  lives 
accomplish  enough,  although  it  will  do  much. 

It  is  necessary,  and  will  always  be  necessary, 
for  an  endless  campaign  of  education  among 
the  people,  most  of  whom  are  heedless  and 
indifferent  to  the  clangers  of  accidents  and 
infections,  and  harm  to  others.  Laws  and 
46 


OF  SICKNESS 

ordinances  will  be  necessary,  and  their  faithful 
execution  more  necessary.  Political  effort  and 
agitation  must  be  continued,  so  that  a  majority 
of  the  people  will  support  all  sane  health 
measures.  The  force  of  law  must  be  felt 
by  the  people  of  all  classes,  especially  the  care- 
less and  indifferent,  to  prevent  them  from 
making  themselves  sick,  (to  the  public  loss), 
and  from  endangering  their  neighbors.  It  is 
unsafe  to  live  in  a  community  where  the 
moderate  precautions  of  a  sane  public  hygiene 
can  be  defied  by  any  man  or  family  with  im- 
punity. 

In  the  last  few  decades  one  European  state 
has  signally  illustrated  this  truth.  During  the 
last  few  years,  the  length  of  the  average  human 
life  has  been  increasing  in  Europe  as  a  whole 
at  the  rate  of  nearly  seventeen  years  per 
century;  in  Prussia  the  gain  has  been  at  the 
rate  of  twenty-seven  years.  Why  is  this? 
It  is  certainly  not  accident  or  any  one  fortui- 
tous circumstance  that  has  done  it.  It  is 
probably  due  to  the  frank  obedience  of  the 
people  to  the  health  rules  of  a  forceful 
government.  The  rules  have  been  formulated 
by  experts  for  the  preservation  of  the  health 
and  the  lives  of  the  people ;  and  all  classes  have 
obeyed  with  hardly  a  question.  If  there  has 
been  a  question  of  the  authority  of  the  state 
in  these  matters,  it  has  been  hushed  in  a  sen- 
timent of  loyalty  to  the  Fatherland. 
47 


THE  ECONOMIC  WASTE 

America  is  learning  slowly  that  government 
is  an  instrument  of  force ;  it  is  learning  a  better 
respect  for  law,  especially  when  the  law  is  for 
the  protection  of  all  the  people.  We  are  out- 
growing the  old  doctrine  that  every  man  has  a 
right  to  do  anything  he  likes,  regardless  of  his 
neighbors,  unless  he  can  see  that  he  is  doing 
them  some  distinct  harm.  The  bugbear  of  pa- 
ternalism is  also  passing,  and  the  mass  of  the 
people  in  the  most  progressive  communities  will 
not  tolerate  the  logical  results  of  the  notion  that 
there  is  no  need  of  public  hygiene. 

It  is  only  by  a  study  of  well-recorded  facts 
bearing  on  the  public  health  that  we  may  surely 
know  whether  or  not  we  are  harming  our 
neighbors.  Prussia  illustrates  the  effect  of 
militarism,  as  applied  to  the  preservation  of 
health,  and  shows  the  value  of  compelling 
people  to  avoid  infection,  carelessness  and 
excesses  that  tend  to  sickness  and  death. 

Will  better  public  health,  gained  by  methods 
that  may  seem  militaristic,  develop  in  the 
people  that  sort  of  vigor  and  virility  that  will 
tend  to  a  martial  attitude  toward  other  nations 
and  threaten  or  produce  war?  Such  a  sus- 
picion is  groundless,  even  childish.  Wars  are 
brought  about  by  human  selfishness,  jealousy, 
egoism,  suspicion  and  hate  between  peoples  and 
rulers  of  peoples.  All  methods  for  better 
health,  whether  forceful  or  otherwise,  are  for 
the  benefit  of  the  nation  employing  them, 

48 


OF  SICKNESS 

and  tend  to  peace — never  toward  war  against 
another  nation,  unless  that  nation  violates 
flagrantly  the  health  interests  of  its  neighbors. 
We  have,  in  this  country,  done  a  few  things 
which  show  that  we  are  becoming  awake  to  the 
need  of  public  and  private  hygiene.  In  some 
of  our  large  cities  we  have,  within  a  few  years, 
lowered  our  annual  death  rate  from  twenty  per 
thousand  of  population  to  fourteen  or  lower, 
largely  as  a  result  of  the  most  constant  watch- 
fulness and  insistence  on  health  regulations. 
Here  are  a  few  of  the  measures  that  have 
brought  down  the  death  rate  and  raised  the 
average  age  of  the  people : 

1.  By  improvement  in  milk  supply  in  cities 
and  towns,  the  amount  of  bad  milk  sold  has 
been  reduced  often  to  less  than  one  tenth  of  the 
former  figure.     This  gain  has  been  made  at 
the    cost    of    stringent    ordinances,    constant 
watchfulness  of  the  milk  supply,  daily  labor- 
atory   examinations    of    the    milk,     frequent 
inspections   of    farms,  herds  and  dairies,  and 
frequent    and    merciless    prosecutions.     And 
the  struggle  goes  on  for  still  better  hygienic  and 
economic  conditions  of  milk  supply — and  there 
is  need  enough  for  it.     Rochester  (N.  Y.)  is 
wasting  a  half  million  dollars  annually  in  the 
way  her  milk  is  delivered  to  her  people. 

2.  Diphtheria  antitoxin,  and  the  almost  uni- 
versal use  of  it  in  cases  of  this  disease,  has 
materially  lowered  the  death  rate.     The  cost 

49 


THE  ECONOMIC  WASTE 

has  been  a  campaign  of  education  of  the 
medical  profession  and  public  as  to  the  life- 
saving  value  of  the  measure ;  the  supply  of  the 
article  free  for  the  poor;  the  examination  of 
throat  specimens  at  public  cost,  and  the 
insistence  on  scrupulosity  in  the  manufacture 
of  antitoxin. 

3.  Improvement  in  water  supply  for  urban 
and    rural    populations,    often    at    enormous 
expense    to    the    public,    has    cost    strenuous 
political,  educational  and  social  campaigns  to 
induce  the   governments   to   vote   the   appro- 
priations.    For  the  effect  of  this  measure  on 
the  death  records  we  need  only  to  look  at  the 
typhoid   mortality   of    two   cities,   before   and 
after.     These  are   Chicago  and   Philadelphia ; 
the  drainage  canal  in  the  former,  and  the  filter 
plant  in  the  latter. 

4.  The   destruction    of    mosquitoes    in   the 
prevention  of  malaria  and  yellow  fever.     These 
fevers  have  been  among  the  most  destructive 
and  expensive  in  all  history.     It  is  impossible 
to  compute  the  annual  cost  of  them  to  the  world 
before  the  mosquito  discoveries,   but   it  must 
have   been   scores   of   millions.     The   cost   of 
mosquito  destruction  has  been  high;  but  it  is 
a  trifle  compared  with  the  cost  of  the  diseases 
they   produced.     The    control    of    plague   and 
cholera  constitutes  a  similar  story.  Like  yellow 
fever,    they    often    occur    in    epidemics.     We 
know  their  microbic  causes,  and  have  learned 

50 


OF  SICKNESS 

how  to  stamp  out  the  epidemics,  and,  to  a 
degree,  how  to  prevent  them.  Dr.  Blue,  the 
head  of  our  federal  health  service,  has  shown 
us  how  these  ends  are  attained;  and  our  Dr. 
Strong,  the  hero  of  Mukden,  has,  in  that  city 
with  a  terrific  epidemic  of  pulmonary  plague, 
accomplished  one  of  the  most  brilliant  feats 
of  control  in  all  history. 

5.  Tenement  house  inspection  and  the  pre- 
vention of  overcrowding  is  a  good  measure  that 
has   met   with   less   popular   opposition   than 
many  other  reforms. 

6.  The    regular    inspection    of    schools    by 
medically  educated  experts  eliminates  children 
capable    of    spreading    infection,    and    helps 
toward  the  relief  of  those  handicapped  by  dis- 
orders that  are  correctable.     This  measure  is 
being  adopted  by  most  progressive  cities,  often 
in  the  face  of  strong  and  persistent  opposition. 
It  is  subject  to  few  drawbacks,  and  has  been 
almost    free    from  abuse.     It   is   increasingly 
popular,  and  ought  to  be. 

7.  Scientific  midwifery  among  the  poor  at 
the   hands   of    selected   dispensary  physicians 
and  visiting  nurses,  and  instructions  to  poor 
and  ignorant  mothers  in  the  care  and  feeding 
of  their  babies  (with  free  milk,  if  necessary). 
By  means  of  these  and  similar  measures,  New 
York  City  has,  within  a  few  years,  reduced  its 
death  rate  among  children  under  one  year  of 
age  by  more  than  30  per  cent.     This  record 

51 


THE  ECONOMIC  WASTE 

will  be  repeated  by  many  other  cities  and  by 
the  more  advanced  country  regions.  But  it 
will  probably  be  a  long  day  before  we  can 
match  New  Zealand,  which  has  the  lowest 
infant  mortality  in  the  world. 

The  poor  people  have,  of  course,  accepted 
these  benefits  gladly,  but  the  public  has  required 
vast  argument  before  voting  the  needed  money. 
With  such  a  record  before  it,  the  public  is 
guilty  of  a  flagrant  waste  of  its  own  substance 
and  of  constructive  manslaughter,  if  it  refuses 
to  supply  the  funds. 

8.  Visiting  nurses  for  the  ordinary  sickness, 
in  cities,  instructing  and  helping  families  that 
need  it,  prevent  a  lot  of   sickness,  and  they 
hasten    recovery    in   many    cases,    and   so   cut 
down     the     cost     of     such     calamities.     The 
governing  bodies  of  cities  are  usually  slow  to 
discover  the  value  of  this  measure. 

9.  Vaccination    against    smallpox    and    ty- 
phoid fever.     That  against  smallpox,  notwith- 
standing bitter  opposition,  has  for  many  years 
been  so  general  that  a  considerable  immunity 
among  the  people  seems  to  have  been  estab- 
lished ;    and    that    against    typhoid    fever    will 
before  many  years,  if  we  can  bring  the  facts 
to  the  knowledge  of  the  people,  become  very 
common — with    the    result    that    typhoid    will 
become  a  rare  disease  in  the  general  community, 
as  it  is  now  in  the  armies  of  the  enlightened 
world. 

52 


OF  SICKNESS 

10.  The  pure  food  and  drug  laws  now  in 
force  in  this  country  have  contributed  to  better 
health  among  the  people,  as  they  have  repressed 
certain    forms   of   unfair   dealing   and    fraud 
among   manufacturers   and   merchants.     This 
reform  was  bitterly  opposed  in  Congress  and 
the   legislatures    for   many    years    by   certain 
powerful  business  interests. 

11.  The  regulation  and  partial  suppression 
of  the  use  of  alcohol  has  cut  out  a  great  amount 
of  useless  expense  to  the  people,  and  it  has 
reduced  the  amount  of  sickness.     This  is  the 
verdict  of  the  statisticians  generally,  notwith- 
standing the  contention  to  the  contrary  by  some 
good  men.     I  believe  that  no  woman  has  made 
such    contention.     We    have    undertaken,    by 
federal  law,  to  suppress  the  popular  use  'of 
opium  and  cocain,  except  in  cases  of  known 
and  necessitous  sickness.    And  public  sentiment 
will  not  allow  this  law  to  be  repealed.     We 
have    made    no    large    attempts    at    reducing 
the    use    of    tobacco,    except    for    children. 
Tobacco  has  been  shown  to  increase  the  death 
rate,  and  the  habit  is  a  money-eater.     Besides 
being    very    costly,    it    is    probably    the    most 
grotesquely  curious  habit  of  the  human  race; 
speaking  generally,  no  one  ever  began  the  use 
of    tobacco   because    he,    by    himself,    at    first 
desired  it.     Probably  a  thousand  million  dollars 
annually  is  spent  because  of  the  tobacco  habit. 

12.  The    fashion    for    fresh    air,    outdoor 

S3 


THE  ECONOMIC  WASTE 

sleeping,  and  athletics  among  students  and  the 
young  generally  is  a  powerful  aid  to  hygiene, 
and  has  lessened  the  death  rate.  Let  us  pray 
that  the  fashion  will  not  change.  Draughts 
of  fresh  air  do  not  cause  colds ;  these  are  due  to 
some  derangement  of  the  body  health.  And 
all  the  advantages  of  a  flood  of  fresh  air  are 
gained  by  a  moderate  amount  of  it,  if  it  is 
kept  in  motion ;  hence  electric  fans  and  a  lesser 
coal  bill  are  in  order. 

13.  Taking  some  tuberculous  patients  off  the 
street  where  they  are  careless  with  their  spu- 
tum, and  sending  them  to  proper  sanatoriums, 
not   only   help    them,    but   protect   the   public. 
Thousands  of  such  patients  are  now  in  such 
places,  where  under  watchful  care  they  harm 
nobody,    and   have   some   chance   of    recovery 
themselves.     Hundreds  of  sanatoriums,  state, 
municipal  and  private,  have  been  built  and  are 
operated  at  great  expense,  but  the  saving  of 
life   has   much   more   than   covered   the    cost. 
The  public  education  as  to  the  dangers  from 
careless   spitting  has   returned   more  value  to 
the  public  than  the  cost  of  all  the  sanatoriums. 
But  this  education  is  not  more  than  a  quarter 
accomplished.     The  propaganda  must  be  kept 
up  until  all  the  people  know  and  remember  the 
facts. 

14.  The  cure  of  hookworm  disease  is  one  of 
the  greatest  gains.     We  are  amazed  that  a  few 
cents'  worth    (less  than  one  day's  wage  of  a 

54 


OF  SICKNESS 

laboring  man)  of  a  harmless  medicine  could 
cure  so  destructive  and  costly  a  disease.  It  is 
now  within  the  possibilities  to  make  uncin- 
ariasis  a  rare  disease,  and  incapable  of  wearing 
out  a  single  patient.  In  Porto  Rico  89,000 
people  were  cured  at  a  cost  of  54  cents  each. 
Other  reforms  must  follow,  and  a  great  and 
united  popular  sentiment  push  forward  all  such 
as  can  minimize  the  sickness  of  mankind,  so 
that  there  shall  be  a  constantly  increasing  num- 
ber of  people  who  will  escape  death  until  over- 
taken by  the  unavoidable  degeneration  of  tissue 
due  to  age.  Even  some  of  these  degenerations 
will  doubtless  be  found  preventable  or  post- 
ponable  to  a  later  time  in  life  than  they  usually 
now  occur. 

Here  are  a  few  of  the  things  to  hope  for : 
(a)  More  educated  health  officers,  and  more 
education  for  them  in  universities.  They  must 
be  sane  people,  men  and  women — certainly 
women  as  well  as  men ! — who  know  how  to  get 
along  with  other  people;  who  can  usually  get 
the  laws  carried  out  with  the  least  friction; 
and  who  respect  the  rights  of  the  people  while 
loyal  to  the  law ;  who  are  jealous  of  the  rights 
of  the  weak  and  helpless ;  and  who  do  not  have 
an  excess  of  official  dignity,  with  projecting 
elbows.  Such  are  people  capable  of  proposing 
new  and  better  health  regulations  than  we  have ; 
and  they  can  convince  the  majority  of  their 
constituents  of  the  necessity  of  progress,  and 

55 


THE  ECONOMIC  WASTE 

of  the  value  of  the  reforms  they  propose. 
Many  health  officers,  like  other  public  servants, 
are  autocratic,  uncompromising  and  apparently 
anxious  to  show  and  use  their  authority. 
Neither  the  cause  nor  the  public  good  needs 
such  servants.  People  in  authority,  when 
obliged  to  use  their  power  in  ways  likely  to 
be  displeasing  to  the  people  affected,  should 
always  regret,  and  act  as  though  they  regretted, 
to  use  their  power  with  severity — and  then  use 
it  politely  if  firmly,  and  only  after  persuasion. 
This  is  the  hand  within  the  velvet  glove  that 
usually  accomplishes  the  difficult  object  with 
thanks  rather  than  execration  from  the  public, 
(b)  Improvement  in  the  hygiene  of  rural 
life  and  rural  schools.  Both  are  disgracefully 
below  the  standard  in  cities.  Country  life 
ought  to  be  the  healthiest  life  of  all ;  and  coun- 
try schools  can,  with  only  moderate  industry, 
be  made  as  wholesome  as  any  school  in  the 
metropolis.  The  movement  by  two  great 
organizations,  the  American  Medical  Associa- 
tion and  the  National  Educational  Association, 
to  further  this  purpose  ought  to  have  our 
hearty  encouragement.  It  is  a  profitable  meas- 
ure and  means  health  and  wealth  for  the  whole 
country.  It  has  not  kept  pace  with  the  progress 
in  the  conveniences  of  country  life,  such  as 
better  roads,  automobiles,  telephones  and  free 
mail  delivery.  The  country  people  are  lament- 
ably neglected  in  the  matter  of  hospital  care 

56 


OF  SICKNESS 

and  expert  nursing.  A  few  of  our  states  have 
awakened  to  the  necessity  of  enabling  counties 
to  provide  proper  hospitals  and  nurses  for  rural 
communities.  This  movement  ought  to  be 
advanced  by  every  means  possible. 

(c)  We  should  teach  early  and  late  the  value 
of   keeping  the  physical  body  up  to  normal 
vigor  all  the  time.    It  wards  off  sicknesses  and 
helps  us  to  weather  them  when  they  are  una- 
voidable,  and   it  often  keeps   us   out  of   the 
expensive  hands  of  doctors  and  nurses.    Early 
diagnosis   of    apparently   trifling    ailments    is 
important.     Severe  diseases  are  thereby  often 
prevented.     This  is  what  the  school  inspection 
doctors  do  for  the  children.     In  sickness,  pro- 
crastination is  one  of  the  most  expensive  and 
dangerous  of  our  indulgences. 

(d)  We  need  to  make  a  more  vigorous  cam- 
paign  against   flies,    mosquitoes   and   vermin. 
Swatting  the  fly  is  good,  but  it  is  a  makeshift. 
We  must  destroy  the  breeding  places  of  flies 
and  mosquitoes.     We   know   the   methods   of 
doing  this,  and  it  is  infinitely  cheaper  than  our 
burden  from  the  unlimited  breeding  of  these 
pests.     But  one  careless  and  indifferent  family 
in  a  neighborhood  can  furnish  breeding  places 
for  the  flies  and  mosquitoes  for  the  town,  and 
nothing  will  do  effectively  but  an  ordinance 
requiring  the  health  officer  to  declare  all  such 
places  to  be  nuisances,   and  to  compel  their 
abatement.     This,  with  public  sentiment  to  sus- 

57 


THE  ECONOMIC  WASTE 

tain  the  officer,  would  reduce  these  insects  to  a 
trifling  inconvenience.  And  one  popular  and 
successful  movement  that  could  enact  such  an 
ordinance  and  cause  its  effective  enforcement 
would  mean  a  general  interest  in  public  health, 
insuring  other  reforms  that  would  give  the 
community  a  nation-wide,  enviable  reputation, 
and  insure  the  lowest  death  rate. 

The  importance  of  body  vermin  in  spreading 
infectious  diseases  has  been  emphasized  by 
recent  studies  in  typhus  fever.  Certain  of  the 
warring  nations  of  Europe  are  profitably 
carrying  out  extensive  measures  for  scrubbing 
the  bodies  of  their  soldiers,  and  disinfecting 
their  clothing  by  heat. 

We  might  profitably  increase  our  facilities 
for  free  baths  for  the  poor  in  cities.  The  bath 
house  might  have  facilities  for  heating  safely 
and  quickly  each  bather's  clothing  while  he  is 
in  the  bath.  The  self-respecting  bathers  would 
probably  resent  the  suggestion  of  vermin  in 
their  clothing,  but  they  would  not  object  to  the 
disinfection  if  told  that  their  clothes  might 
contain  tubercle  or  typhoid  bacilli,  and  that  the 
oven  would  not  harm  the  garments. 

(e)  We  ought  to  make  a  larger  effort  to 
lessen  the  spread  and  havoc  of  the  venereal 
diseases.  The  economic  loss  to  the  nation 
from  them  is  beyond  computation.  The  results 
are  great  suffering,  disabling  complications  that 
are  sometimes  mortal,  blindness,  insanity,  bar- 

58 


OF  SICKNESS 

renness,  locomotor  ataxia,  aneurysms,  loss  of 
service  and  other  multiplied  calamities.  The 
list  is  long  and  sickening.  And  the  diseases 
are  widespread,  especially  in  cities.  In  New 
York  in  one  year  the  number  of  cases  was 
over  4  per  cent,  of  the  whole  population. 

We  have  done  a  few  things  to  lessen  them  a 
little,  mostly  working  around  the  edges  of  the 
problem,  as  it  were,  without  attacking  it  in  the 
direction  of  its  greatest  menace.  We  have  to 
some  degree  banished  the  promiscuous  drink- 
ing cup  in  public  places,  on  railroad  trains,  and 
where  numbers  of  people  are  employed.  This 
helps  a  little,  and  is  a  good  object  lesson  in 
hygiene. 

We  have  advised  against  promiscuous  lip 
kissing,  with  small  result  to  change  a  fashion. 

We  have  encouraged  the  use  of  domestic  and 
toilet  facilities  that  tend  to  lessen  the  spread  of 
the  diseases. 

We  are,  with  admirable  unanimity,  success- 
fully fighting  against  segregation  and  official 
examination  of  prostitutes.  This  will  remove 
somewhat  the  temptation  to  men  and  boys 
towards  the  dark  ways — with  a  fatuous  sense 
of  safety  that  never  exists. 

We  have  reduced  somewhat  the  use  of  alco- 
holics, for  these  have  led  countless  thousands 
of  men  and  boys  to  contract  these  diseases, 
who  otherwise  would  have  had  enough  cau- 
tion, self-respect  and  resolution  to  avoid 
exposure  to  them. 

59 


THE  ECONOMIC  WASTE 

We  have  begun  to  get  over  our  cowardice 
and  prudery,  and  to  give  a  few  boys  and  girls 
some  slight  knowledge  of  sex  hygiene  and  how 
to  avoid  these  infections. 

We  have,  by  an  admirable  addition  to  the 
principles  of  medical  ethics,  unlimbered  the 
tongues  and  courage  of  physicians  who  can  and 
will,  better  than  formerly,  protect  women 
known  to  them  to  be  in  danger  through  ex- 
pected marriage.  The  certificates  of  perfect 
health  before  marriage  that  a  few  clergymen 
are  demanding  will  do  a  little  good,  but  not 
much,  because  of  accommodating  physicians 
and  careless  examinations  by  those  unskilled. 

Surgeons,  in  treating  these  diseases,  are 
more  cautious  than  formerly  to  avoid  infection, 
by  the  use  of  rubber  gloves  and  other  devices. 

We  have  seen  most  of  a  certain  class  of  doc- 
tors shamed  against  further  spreading  of  that 
abominable  physiologic  heresy  that  the  health 
of  any  man  requires  sexual  indulgence.  Their 
subsidence  has  undoubtedly  lessened  a  little 
the  spread  of  these  diseases,  as  it  has  lessened 
the  degradation  of  man. 

We  are  more  and  more  providing  quick  and 
efficient  hospital  and  dispensary  care  for  the 
poor  who  are  overtaken  by  these  infections,  for 
this  is  humane,  and  is  a  protection  to  the  com- 
munity. Every  such  patient  is  a  constant 
menace  to  the  people  about  him. 

Lastly,   we   are   preaching   the   gospel   of   a 

60 


OF  SICKNESS 

single  standard  of  morality  for  men  and 
women  alike.  This  is  right  as  well  as  right- 
eous, and  will  do  good  as  far  as  it  goes ;  but 
with  a  present  record  of  60  per  cent,  of  syph- 
ilitic women,  having  received  the  infection 
from  their  husbands,  it  is  to  be  feared  that  it 
will  not  for  many  years  greatly  influence  the 
spread  of  venereal  diseases.  Not  1  per  cent. 
of  syphilitic  men  receive  the  infection  from 
their  wives. 

Probably  the  most  effective  means  within 
our  power  to  lessen  greatly  the  spread  of  these 
diseases  is  the  general  education  of  the  young 
of  both  sexes  as  to  their  nature,  their  baneful 
effects  and  the  way  to  avoid  them.  But  this 
measure,  clearly  the  right  of  every  boy  and  girl 
to  have  for  their  own  protection,  and  much 
desired  by  them,  is  strongly  opposed  by  many 
good  people  for  reasons  that  seem  to  me  utterly 
inadequate  and  even  nonsensical.  May  the 
wisdom  of  these  sensitive  people,  the  love  of 
their  kind,  their  respect  for  essential  purity  and 
the  rights  of  the  young  so  increase  that  they 
may  come  to  know  that  whatever  knowledge  is 
necessary  in  order  to  be  healthy  and  avoid 
death  is  proper  for  young  and  old  alike;  and 
that  not  forever  shall  the  best  youths  of  our 
land  be  allowed  by  their  ignorance  to  go  blindly 
to  their  destruction. 

(f)  Finally,  and  never  to  be  forgotten,  the 
progress  we  have  made  in  cutting  down  the 

61 


THE  ECONOMIC  WASTE 

death  rate  has  been  due  to  the  results  of  scien- 
tific research  during  the  last  few  decades.  But 
for  this  research  we  would  still  have  a  death 
rate  in  our  cities  of  twenty  to  twenty- four  per 
thousand  annually  instead  of  fourteen  or  less.1 
In  this  progressive  work  the  pathologists  of 
America  have  had  a  great  part. 

The  wonderful  results  so  far  achieved  are  a 
promise  of  greater  yet  to  come,  and  tubercu- 
losis, cancer,  diabetes,  pneumonia  and  other 
destroyers  of  mankind  will  be  conquered.  The 
public  health  weather  vane  points  to  more  en- 
dowment of  research,  and  that  is  what  we  most 
need.  The  workers  are  ready,  but  the  public 
says  the  endowments  are  expensive.  That  is 
true,  but  the  beneficial  results  are  one  hundred- 
fold greater  than  the  cost. 

The  promise  of  further  reduction  in  the 
death  rate  is  in  two  factors  only :  the  more 
efficient  use  of  the  knowledge  which  research 
has  already  given  us,  and  of  the  new  knowledge 
which  further  research  is  bound  to  produce. 
On  this  progress  we  pin  our  faith,  in  the  calm 
certainty  that  it  will  not  fail  us. 

1  In  1921  the  death  rate  of  many  cities  in  the  United  States 
was  11  per  1000  of  population,  or  less. 


62 


A  Defraudation  of  Youth 


A  Defraudation  of  Youth* 


There  is  constantly  being  lost  in  this  country 
a  vast  amount  of  the  best  potential  promise  of 
childhood  and  youth,  by  a  neglect  that  cannot 
be  defended  on  any  ground  whatever.  Not 
only  is  power  lost,  but  happiness  as  well;  and 
nobody  is  benefited  by  the  waste. 

The  punishment  falls  on  a  class  of  excep- 
tional and  usually  bright  children,  who  happen 
to  be  unfitted  for  the  particular  gait  of  the 
majority.  The  mischief  mostly  occurs  during 
the  school  period  of  life,  when  the  child  is 
acquiring  his  mental  working  tools,  and  mak- 
ing preparation  for  what  ought  to  be  forty 
productive  years. 

This  period  of  life  is  vital  for  the  future, 
both  for  the  child  and  the  community,  for  our 
civilization  depends  on  the  continuous  mental 
training  in  youth  of  the  oncoming  generations, 
which  take  the  places  of  those  that  are  passing 
away.  The  subjects  taught,  and  the  teaching 
methods,  acquire  more  or  less  of  a  standardiza- 
tion, and  attain  veneration  in  the  public  mind — 


*Read   before    the   Chicago   Woman's    Club,    November 
1916. 

65 


A  DEFRAUDATION  OF  YOUTH 

because  they  do  maintain  our  civilization. 
The  curricula  become  to  us  more  or  less  sacred, 
and  therefore  difficult  to  change. 

But  our  civilization  gradually  changes,  and 
perhaps  improves.  It  cannot  improve  without 
the  methods  and  substance  of  education  chang- 
ing and  improving  also.  Education  rises  and 
falls  and  varies  with  changes  in  the  social  order. 
The  teaching  ought  to  be  the  means  of  raising 
the  standard ;  but  too  often  the  pedagogues 
worship  the  past,  are  fixed  in  their  methods, 
and  refuse  to  change  until  they  are  forced  to 
it,  or,  this  failing,  are  pushed  out  of  the  schools 
altogether.  Progressive  innovations  in  teach- 
ing methods  and  matter,  those  that  have  been 
potent  in  raising  our  social  and  civic  power, 
have  usually  met  opposition  from  schools  and 
colleges,  which  have  adopted  them  reluctantly. 

The  government  of  our  country  is  a  great, 
costly  business  organization — in  the  main,  poor- 
ly managed.  It  costs,  for  federal,  state,  county 
and  city  governments,  probably  ten  billion  dol- 
lars annually.  One  of  the  largest  items  of 
expense,  as  one  of  the  largest  public  jobs,  is 
that  of  education.  We  spend  for  public  schools 
probably  half  a  billion  dollars,  yearly;  and 
the  private  schools  and  those  of  higher  educa- 
tion, including  the  colleges,  cost  at  least  a  hun- 
dred million  more.  All  this  to  enable  us  to 
keep  our  civilization  level  or  possibly  to  give  it 
a  slightly  upward  trend  ;  all  this  to  enable  our 

66 


A  DEFRAUDATION  OF  YOUTH 

people  to  be  born  and  live  as  best  they  may  for 
an  average  of  less  than  fifty  years  each ! 

Any  sensible  suggestion  of  economy  in  this 
business,  whether  in  money,  time,  human  effort 
or  life,  deserves  the  public  ear.  And,  for  the 
purposes  of  this  argument,  we  must  postulate 
that  education  ought  to  equip  a  child  to  do 
things  as  well  as  to  know  them ;  and  to  be  more 
than  a  machine  to  do  things,  however  useful — 
to  attain  the  highest  ideal  he  is  capable  of 
in  manhood ;  to  have  a  wide,  useful  body  of 
knowledge — besides  some  wisdom  and  char- 
acter. 

For  vigorous  people  our  educational  methods 
that  are  venerable  and  more  or  less  sacred,  do 
fairly  well,  although  many  of  them  are  wasteful 
of  time  and  nerves,  are  unpractical,  and  hate- 
ful to  many  pupils.  For  a  large  number  of 
weakly  or  otherwise  physically  handicapped, 
bright  children,  they  are  inadequate,  misfitting, 
often  cruel,  and  generally  inept. 

One  of  the  boasted  glories  of  this  later  time 
is  that  we  have  saved  the  lives  of  many  chil- 
dren that  formerly  were  lost,  and  that  this  is 
a  duty  of  our  civilization.  So  our  average 
longevity,  instead  of  being  as  formerly,  30 
years  or  less,  is  now  45  or  more.  This  increase 
of  at  least  fifty  per  cent,  is  due  largely  to  the 
greater  survival  of  babies  and  children,  and 
less  to  prolonged  life  of  the  aged. 

But  our  lives  grow  more  artificial  with  each 

67 


A  DEFRAUDATION  OF  YOUTH 

decade;  our  inventions  make  living  easier  in 
some  ways,  but  in  business  and  work  they  often 
restrict  us  to  a  narrow  range  of  mental  and 
bodily  movements;  and  some  of  our  vocations 
are  debilitating,  even  directly  disease-pro- 
ducing. 

One  of  the  consequences  of  some  generations 
of  this  sort  of  influence  is  a  large  number  of 
unvigorous  and  high-strung  children.  This  is 
exactly  what  any  thoughtful  hygienist  must 
have  known  would  happen,  if  no  countervailing 
measures  were  resorted  to ;  and,  true  to  our 
habits  of  unpreparedness,  no  such  steps  are 
thought  of  until  the  trouble  is  upon  us.  Now, 
an  increasing  proportion  of  children  have  weak 
bodies  with  bright  minds — weak  nerves,  mus- 
cles, hearts  or  lungs,  too  much  headache,  too 
little  endurance,  too  much  sensitiveness  and 
irritability — too  much  intellectual  precocity. 

Quite  a  number  of  children  are  brought  to 
this  condition  not  by  prenatal  influences, — 
which  is  common  enough — but  as  an  after 
result  of  some  sickness  that  formerly  would 
have  killed  them,  but  which  they  have  survived 
by  the  grace  of  modern  therapeutics  and 
hygiene.  I  know  there  are  so-called  philos- 
ophers who  say  that  such  children  had  better 
die  than  live  handicapped ;  and  some  tribes 
actually  destroy  such  children.  The  true  phil- 
osophy is  to  remove  the  handicap — and  it  is 
often  possible  to  do  this.  But  in  order  to  do  it, 

68 


A  DEFRAUDATION  OF  YOUTH 

all  these  children,  whatever  the  origin  of  their 
disadvantage,  must  have,  during  their  growing 
and  developmental  years,  such  conditions  of 
life  as  will  minimize  or  counteract  their  abnor- 
mal states,  and,  if  possible,  bring  them  to 
adulthood  with  at  least  fair  vigor  and  promise 
of  a  career. 

Most  of  these  children  are  capable,  under 
right  conditions,  of  great  progress  in  learning 
both  in  and  out  of  school,  of  usefulness  and 
happiness;  and,  in  well  chosen  vocations,  of  a 
normal  life  of  the  average  length.  Many  of 
the  great  characters  of  history  have  belonged  to 
this  class.  For  their  success,  as  well  as  to 
make  their  lives  endurable,  they  need  two 
things,  and  these  are  among  their  natural  rights 
that  ought  to  be  inalienable.  One  is  that  they 
shall  gain  rather  than  lose  in  bodily  and  ner- 
vous vigor  while  being  educated ;  and  the  other 
that  in  school  they  shall  be  taught  those  things, 
and  those  chiefly,  that  will  help  them  to  live 
the  lives,  and  work  at  the  tasks  that  they  are 
fit  for. 

Thousands  of  boys  and  girls  break  down 
in  school  and  college  from  the  kind  and  condi- 
tions of  their  study  and  their  irrational  manner 
of  living.  They  have  no  surplusage  of  vigor, 
their  diminished  supply  is  used  up  in  their  in- 
dispensable activities.  Some  of  them  drop  out 
for  a  term  or  a  year  and  lose  their  places  in 
their  class,  then  go  back  to  school  and  try  to 
69 


A  DEFRAUDATION  OF  YOUTH 

keep  up  with  a  later  class — perhaps  to  break 
down  again,  with  all  the  attendant  disappoint- 
ments and  chagrin. 

That  such  things  happen  is  proof  that  some- 
thing is  wrong  with  the  system.  Both  the 
curriculum  and  the  regimen  ought,  for  these 
students,  to  be  changed.  No  pupil  ought  in 
school  work  to  break  down,  if  he  is  able  to  play 
— this  truth  is  axiomatic.  Practically  nobody 
breaks  down  from  over-study  pure  and  simple ; 
but  many  do  from  worry,  rebellion  against 
their  work,  envy,  jealousy,  fear  and  anger, 
from  worry  over  examinations  and  failures; 
and  from  grossly  improper  health  conditions  in 
their  school  life.  They  have  impaired  diges- 
tion, insomnia  and  general  debility,  and  as  a 
consequence,  they  easily  acquire  various  mi- 
crobic  and  other  diseases.  For  many  of  them, 
the  world  periodically  looks  very  black;  some 
of  them  are  tempted  to  commit  suicide,  and  a 
few  actually  do.  This  latter  fact  is  no  neces- 
sary indictment  of  these  young  people;  the 
records  of  Germany  show  a  many-fold  larger 
proportion  of  such  suicides. 

The  schools  and  colleges  ought  to  be  like  life 
at  a  health  resort  or  on  vacation,  always  increas- 
ing, never  lowering,  the  vigor  of  the  students. 
And  this  is  possible  with  a  free  resort  to  com- 
mon sense,  in  the  light  of  modern  knowledge, 
and  without  any  serious  violence  to  our  educa- 
tional habits.  The  schooling  of  all  youths 

70 


A  DEFRAUDATION  OF  YOUTH 

should  be  so  arranged  as  to  be  enjoyable ;  with 
the  handicapped  children  this  is  indispensable. 

The  best  thing  for  a  tired  and  unvigorous 
youth  is  to  be  thrust  into  some  new  environ- 
ment, out-of-doors  to  new  scenes  and  experi- 
ences, some  new  sort  of  exercise  or  game,  some- 
thing that  spurs  his  enthusiasm,  so  that  each 
night  he  comes  in  with  his  mind  full  of  the 
pleasures  and  surprises  of  the  day,  and  ready  to 
talk  an  hour  about  them.  Under  such  a  regime 
vigor  of  mind  and  body  is  renewed;  and  the 
joy  of  an  avid  mind,  daily  filled  and  refreshed, 
is  as  truly  uplifting  as  the  outdoor  life  and  the 
exercise. 

I  propose  that  the  education  of  such  uncom- 
mon children  shall  be  carried  on  in  the  joyous 
equivalent  of  a  continuous  vacation.  And  this 
is  possible  while  giving  them  more  useful 
knowledge  and  training  than  they  can  get  out 
of  the  standard  methods ;  and  not  less  valuable 
for  mental  discipline.  Best  of  all,  this  sort  of 
training  fits  them  for  the  business  and  joys  of 
life  better  than  the  traditional  scheme.  School 
work  should  always  seem  to  the  student  to  be 
play,  and  usually  it  can  be  made  so. 

For  the  realization  of  this  ideal,  several 
things  are  necessary.  The  first  step  is  to  seg- 
regate the  handicapped  students,  and  make  a 
course  of  study  and  living  for  them  that  is 
adjusted  to  their  needs.  The  living  must  be 
hygienic  in  a  severe  degree,  like  that  of  the 

71 


A  DEFRAUDATION  OF  YOUTH 

athletic  team.  Every  student  must  have  daily 
exercise — just  enough,  never  too  much;  if  he 
does  not  get  enough  of  it  from  shop,  outdoor 
work  and  play,  he  must  have  selected  gymnas- 
tics, without  any  attempt  to  develop  an  athlete. 
High  athletic  development  is  beautiful  and 
thrilling  for  the  day,  but  a  harm  rather  than  a 
benefit  for  the  hoped-for  long  tomorrow  of  the 
individual  life.  Regular  measurements  must 
be  made  and  recorded  of  each  student  from 
time  to  time,  to  mark  the  physical  development 
in  all  directions ;  and  wherever  needed  correc- 
tive training  under  expert  guidance  should 
be  insisted  on. 

As  to  food,  hours  in  bed,  outdoor  life  and 
abstention  from  stimulants,  the  rules  would  be 
inexorable.  Lights  out  at  nine  o'clock  would 
become  the  law,  and  the  hope  of  the  social  dis- 
sipations, so  common  today,  would  have  to  go 
out  with  the  lights.  This  would  not  exclude 
wholesome  social  pleasures,  and  the  sum  total 
of  joy  would  in  the  long  run  be  greater  for  the 
change. 

The  ordinary  school  room  should,  as  far  as 
possible,  give  place  to  outdoor  work  and  study. 
This  is  easy  enough  in  any  climate,  as  has  been 
demonstrated  many  times  over  in  our  northern 
cold  winters.  Instead  of  indoor  class  work, 
laboratory,  shop  and  workroom  study  should, 
as  far  as  possible,  be  the  rule.  They  are  more 
educative  than  the  other,  and  more  enjoyable 

72 


A  DEFRAUDATION  OF  YOUTH 

than  any  other,  with  the  possible  exception  of 
field  study.  Those  studies  that  are  enjoyed 
most  make  the  most  lasting  effect  on  the  mind ; 
and  it  is  a  mild  slander  on  psychology  to  say 
that  a  study  that  is  irksome  is  needful  for  men- 
tal discipline.  Other  things  being  equal,  irk- 
some studies  are  rarely  commendable  unless 
they  are  necessary  to  impress  the  student  with 
the  force  and  effect  of  law.  But  most  irksome 
studies  cease  to  be  such  when  they  can  be 
taught  in  a  practical  way.  It  is  the  experience 
of  probably  all  manual  training  schools  that 
pupils  take  to  certain  studies  with  great  avidity 
as  taught  by  shop  work  and  tools,  when  they 
had  previously  rebelled  stoutly  against  them  as 
memory  studies  out  of  books. 

One  great  need  of  the  students  of  the  past 
and  only  a  lesser  one  of  the  present,  is  more 
training  of  the  powers  of  observation  and  of 
interpretation  of  the  things  observed.  There 
has  all  along  been  too  little  of  this  and  too 
much  time  and  attention  given  to  memory 
studies.  The  latter  rather  lessen  the  power  of 
observation  and  of  doing  things,  but  the  course 
of  study  here  commended  directly  favors  the 
growth,  because  it  exercises  the  function,  of 
observation  in  the  most  effective  manner.  The 
almost  total  absence  of  such  powers  in  many 
so-called  highly  educated  persons  is  a  pathetic 
vision  of  our  daily  experience.  The  men  and 
women  who  are  the  most  efficient  and  success- 
73 


A  DEFRAUDATION  OF  YOUTH 

ful  in  the  world's  affairs  are  those  with  the 
greatest  average  powers  of  observation  and  in- 
terpretation. The  thoughts  that  direct  and 
attend  physical  acts,  as  in  well  designed  play 
or  certain  kinds  of  work — work-play — are 
most  effective  of  all  in  fixing  ideas  and  increas- 
ing power ;  that  is,  in  creating  cerebral  automa- 
tisms— which  are  the  basis  of  all  education. 

Why  is  a  farm-bred  boy  more  effective,  other 
things  being  equal,  than  the  city-bred?  His 
observation  and  interpretation  are  keener;  he 
has  handled  the  tools. 

The  proposed  curriculum  would  contain  only 
a  third  to  a  half  of  the  current  school-room 
memory  work.  The  practical,  manual,  obser- 
vational and  outdoor  studies  would  be  greatly 
increased.  For  details.  I  should  say  that  the 
cutting  down  of  studies  would  be  mainly  in 
higher  mathematics,  ancient  languages  and  lit- 
erature, ancient  history,  certain  phases  of  phil- 
osophy, and  in  formal  grammar.  Of  course, 
the  cut  would  be  adjusted  to  the  needs  of  indi- 
viduals; and  for  vocational  requirements  a  cer- 
tain student  might  need  exhaustive  drill  in  any 
one  of  these  subjects. 

While  a  profound  knowledge  of  any  one  of 
such  eliminable  studies  may  be  desirable  for 
a  particular  student,  fitting  for  a  career  that 
requires  it,  it  is  absurd  that  every  one  should 
take  thorough  work  in  the  whole  list  because 
one  in  forty  may  need  to  master  one  or  tivo 

74 


A  DEFRAUDATION  OF  YOUTH 

of  them;  for  the  thirty-nine  would  then  be 
fated  to  neglect  the  more  practical  studies  that 
are  vital  for  their  health  and  success  in  life — 
which  would  be  wicked  as  well  as  absurd. 
That  sort  of  defraudation  of  the  many  for  the 
few  has  gone  on  too  long  already. 

I  know  there  is  an  outcry  against  cutting 
down  Latin,  Greek  and  the  higher  mathematics, 
because  they  are  venerable  and  are  reputed  to 
be  good  for  mind  building,  if  there  is  such  a 
thing.  But  our  erudite  veteran  in  educational 
betterment,  Dr.  Eliot,  years  ago  saw  that  we 
had  long  overdone  the  teaching  of  these  and 
kindred  subjects,  to  the  exclusion  of  more  prac- 
tical, useful  and  enjoyable  ones;  and  he  has 
stripped  naked  the  fetish  that  only  with  these 
studies  rests  the  power  of  discipline  of  the 
mind.  He  has  for  many  years  constantly 
urged,  and  still  urges,  a  wiser  course  of  study. 
If  the  educational  world  has  followed  him 
slowly  and  from  afar,  it  still  moves  in  his  direc- 
tion. And  in  some  quarters  the  progress  is 
fast  enough  to  satisfy  the  most  radical. 

While  that  younger  reformer,  Dr.  Abraham 
Flexner,*  is  a  more  impetuous  and  perhaps  less 
judicial  iconoclast  than  Dr.  Eliot,  we  owe  him 
a  debt  of  gratitude  for  stimulating  the  teaching 
profession  to  keep  somewhere  near  abreast  of 
the  activities  of  the  world.  Of  course,  this 


*I  commend  two  articles,  one  by  each  of  these  writers,  on 
the  needs  of  education,  recently  published  by  the  General 
Education  Board. 

75 


A  DEFRAUDATION  OF  YOUTH 

profession  does  invaluable  service  to  civiliza- 
tion, but  its  very  business  tends  toward  fixation 
in  methods,  language  and  substance;  and  this 
may  easily  become  fossilization.  The  diction- 
aries, the  school  methods  and  the  live  languages 
will  not  stay  as  they  were — only  dead  things  do 
that.  They  are  always  changing  and  evolving ; 
and  teachers  of  all  classes  ought  to  be  progress- 
ive, have  open  minds,  and  not  denounce  meth- 
ods merely  because  they  are  new. 

The  studies  added  in  the  proposed  scheme 
would  include,  among  others  and  in  various 
combinations,  Zoology,  Biology,  Geology,  Agri- 
culture, Forestry,  Chemistry  of  Foods  and 
Poisons  of  the  body,  as  well  as  the  various 
physical  interests  of  our  daily  lives ;  and  both 
personal  and  public  hygiene.  There  should 
be  some  knowledge  of  surveying  for  all  boys, 
and  of  Bookkeeping,  Exchange,  Banking,  Fi- 
nance and  Government  for  both  boys  and  girls. 
Several  of  those  studies  can  be  pursued  best 
in  the  fields,  the  woods  and  the  mountains.  And 
this  fact  is  a  lodestone  to  pull  the  most  mettle- 
some students  out-of-doors,  where  they  belong 
much  of  the  time. 

Our  physical  existence  depends  absolutely 
on  the  lives  of  plants  and  animals  about  us, 
and  death  finally  comes  to  most  of  us  by  some 
of  the  microscopic  lives.  Therefore  Biology 
—the  science  of  life— especially  Bacteriology, 
should  be  a  required  study  in  every  school  and 

76 


A  DEFRAUDATION  OF  YOUTH 

college.  And  it  should  be  studied  not  from 
books  only,  but  in  the  laboratory  with  test 
tubes,  culture  media  and  microscopes.  No 
other  study  so  much  as  this  arms  a  youth  to 
defend  his  own  physical  life  from  destruction 
— and  that  is  the  first  duty  of  every  one  of  us. 
Every  vigorous  boy  is  in  danger  of  going 
wrong  in  a  way  to  ruin  him  and  later  those  he 
loves.  This  study  is  the  most  effective 
warning. 

Vocational  study  should  have  a  cardinal  place 
whenever  possible.  All  students  do  not  know 
what  their  life  vocations  ought  to  be  or  can  be ; 
but  their  fancy  and  the  composite  judgment  of 
teachers,  parents  and  friends,  should  combine 
to  fix  tentatively  the  future  vocations  of  many 
of  them ;  and  these  can  then  work  toward  effi- 
ciency in  the  lines  selected.  It  is  the  business 
of  a  good  school  to  help  them  to  do  this.  For 
very  obvious  reasons  the  Spanish  language 
should  be  a  required  study. 

The  sharp  segregation  of  the  vocations  of 
men  from  those  of  women,  is  becoming  less 
and  less  important.  Women  are  taking  the 
places  of  men  in  many  vocations  that  formerly 
they  neither  sought  nor  were  allowed  to  enter. 
The  present  war  has  given  us  many  surprises 
of  this  sort.  There  is  a  brilliant,  refined  Eng- 
lish woman  in  this  country  now,  who  is  a  major 
in  a  corps  of  women  in  London,  whose  duty  it 
is  to  run  to  the  aid  of  people  injured  by  bombs 
77 


A  DEFRAUDATION  OF  YOUTH 

dropped  from  the  air.  They  go  in  automobiles 
which  they  alone  operate.  They  are  able  to 
render  every  aid  that  a  corps  of  men  could. 
Every  one  of  them  has  become  an  expert  in  the 
construction  and  handling  of  an  automobile. 
Months  ago  they  were  given  a  dozen  broken- 
down  autos  of  identical  construction.  They 
took  them  all  apart,  then  assembled  the  service- 
able parts  into  three  or  four  effective  machines 
which  they  are  now  using,  and  some  of  these 
have  traveled  6,000  miles  without  a  break. 
Not  a  man  touched  a  hand  to  this  job.  In 
nearly  every  city  in  this  country  are  young 
women  driving  automobiles  with  safety  and 
success  equal  to  men. 

There  are  certain  practical  subjects  that 
every  one  should  know  something  about ;  they 
are  matters  of  so  nearly  e very-day  need  and 
contact  that  they  cannot  be  omitted  from  any 
system  broadly  deserving  to  be  called  educa- 
tional. For  example,  every  girl  should  have 
some  knowledge  of  machinery — the  sewing  ma- 
chine, the  type  machine  and  the  modern  auto- 
mobile at  least ;  she  should  know  how  to  whittle, 
to  sharpen  a  pencil  neatly,  to  drive  a  nail,  han- 
dle a  screw-driver,  a  saw  and  a  monkey  wrench. 
She  should  know  a  lot  about  domestic  science 
and  art  in  every  phase,  including  the  chemistry 
and  nutritive  value  of  foods,  as  well  as  the 
chemistry  and  physics  of  cooking  and  otherwise 
preparing  them.  She  must  certainly  learn 

78 


A  DEFRAUDATION  OF  YOUTH 

about  architecture — sufficient  to  plan  a  house 
for  herself  and  know  whether  she  gets  the 
things  the  plans  call  for;  so  she  must  know 
about  gas  fitting  and  burning,  about  plumbing, 
sewerage,  ventilation,  house-heating  and  elec- 
tric wiring  and  lighting — all  of  which  she  will, 
if  she  is  quite  sane,  study  with  both  enthusiasm 
and  success  if  she  only  has  the  chance.  The 
melancholy  fact  is  that  to  most  girls  the  chance 
never  comes. 

All  boys  ought  to  be  compelled  to  know 
something  about  machinery,  such  as  that  of 
railroads,  the  construction  and  operation  of  an 
automobile,  a  printing  press,  and  the  methods 
and  means  of  preparing  for  the  market  and 
use  of  various  utensils,  fabrics  and  foodstuffs. 
They  would  profit  by  learning  the  general 
and  technical  workings  in  some  detail  of  one 
or  two  large  up-to-date  manufacturing  con- 
cerns. To  learn  one  such  thing  thoroughly 
creates  the  ability  to  grasp  others  easily.  Can 
you  imagine  many  boys  being  compelled  to 
learn  about  such  things  ?  The  average  normal 
boy  jumps  at  the  opportunity  to  learn  them. 

The  studies  here  recommended,  many  of 
them,  take  the  students  out-of-doors,  entice 
them  out  of  the  school  room,  and  so  help  to 
give  the  effect  of  a  vacation.  They  develop  the 
useful  power  of  observation;  and  with  this 
comes  the  capacity  for  invention  and  initiative. 
They  help  to  equip  any  student  to  earn  his  liv- 
79 


A  DEFRAUDATION  OF  YOUTH 

ing  by  his  wits  instead  of  with  his  hands,  and 
help  powerfully  to  increase  rather  than  lower 
his  vigor;  and  they  send  him  out  into  the  world 
with  better  expectancy  of  life  and  usefulness. 
Wherever  these  methods  have  been  tried,  even 
in  a  tentative  way,  for  the  children  and  youths 
that  most  need  them,  they  have  all  promptly 
shown  improvement  by  contentment  of  mind, 
more  ambition,  better  physical  condition,  fewer 
physical  discomforts  and  less  sickness. 

But  there  are  drawbacks  to  this  fine  ambi- 
tion. It  will  not  for  a  long  time  be  fashionable 
and  so  a  great  many  students  who  need  it  will 
dread  and  refuse  it,  even  if  offered  to  them. 
Boys  and  girls  hate  to  be  out  of  fashion,  and 
will  endure  all  sorts  of  discomforts  and  priva- 
tions to  get  into  it — as  some  boys  do  to  learn  to 
smoke.  I  have  known  boys  to  struggle  daily 
against  tobacco  nausea  for  three  months  before 
they  could  graduate  as  true  smokers.  The 
courage  of  the  parents  will  in  some  cases  coun- 
teract the  cowardice  of  their  children,  and 
so  after  a  while  a  new  vogue  in  education  may 
develop.  But,  alas,  a  useful  innovation  does 
not  always  or  often  develop  a  fashion. 

The  best  hope  is  that  some  college  may  grad- 
ually adopt  the  measures  here  recommended. 
It  will  be  easy  to  do  this  so  far  as  the  studies 
are  concerned,  if  the  college  president  believes 
in  it,  and  has  initiative  and  courage.  There 
will  be  more  difficulty  with  the  regimen,  the 

80 


A  DEFRAUDATION  OF  YOUTH 

mode  of  living.  Students  dislike  to  be  put  on 
a  special  regimen  not  justified  by  their  own 
superiority,  (like  that  of  the  athletic  team),  but 
rather  indicating  some  inferiority.  The  young 
dislike  to  be  called  odd,  unless  that  means  the 
possession  of  an  admitted  special  virtue  of 
some  sort,  some  physical  charms  that  their  fel- 
lows do  not  and  cannot  have,  like  dimples,  a 
wealth  of  attractive  hair,  a  tapering  waist,  or 
small  hands  and  feet. 

Another  drawback  will  be,  at  first  if  not  con- 
stantly, an  increase  in  the  expense.  More  and 
better  teachers  with  varied  education  and  great 
tact  will  be  required,  and  more  apparatus  and 
facilities,  all  of  which  call  for  more  money. 
But  notwithstanding  the  cost,  it  pays.  Twice 
the  cost  is  not  too  much  to  pay  for  such  an  edu- 
cation for  such  youths ;  for  it  makes  for  many 
of  them  the  difference  between  a  large  success 
in  life  with  a  fine  career,  and  relative  help- 
lessness. 

Colleges  whose  classes  are  full  will,  for  this 
reason,  as  well  as  because  it  means  an  innova- 
tion that  is  disturbing,  refrain  from  making 
such  unusual  provision  for  a  group  of  students. 
Even  the  known  presence  of  such  students  with 
their  peculiar  studies  and  living,  might  be  ex- 
pected to  deter  some  stalwarts  from  coming, 
and  that  would  look  like  a  calamity.  But  I 
deny  such  a  slander  against  the  average  stal- 
wart student ;  for  he  is  not  a  cad,  but  a  fellow 
81 


A  DEFRAUDATION  OF  YOUTH 

with  essential  chivalry  that  he  would  scorn  to 
boast  of. 

While  the  colleges  will  hesitate,  yet  any 
great  progress  must  start  with  the  colleges  for 
the  secondary  schools  will  be  sure  to  order  their 
work  so  as  to  make  their  graduates  acceptable 
to  the  colleges.  But  the  schools  could,  if  they 
really  desired  and  were  paid  for  it,  do  better 
things  than  they  have  done  for  the  boys  and 
girls  who  are  not  going  to  college,  and  these 
are  a  majority  of  their  students.  Some  col- 
lege, with  a  true  progressive  and  missionary 
spirit,  will  some  day  start  such  a  work  for  the 
good  it  is  sure  to  do. 

If  a  few  colleges — most  probably  the  smaller 
ones — would  begin  such  reforms,  it  might  by 
and  by  become  the  fashion,  and  so  help  to  re- 
move the  opprobrium  that  many  of  the  masters 
of  industry  have  put  upon  the  colleges,  namely, 
that  their  graduates  are  useless  for  the  tussle 
of  the  world,  until  they  have  been  taught  some- 
thing useful,  by  elbowing  the  world. 

The  measures  here  advocated  must  not  be 
confused  with  a  number  of  educational  inno- 
vations already  instituted  for  unusual  children. 
There  are  schools  for  the  grouping  together  in 
special  classes  of  those  precocious  children  who 
learn  or  rather  remember  so  rapidly  that  they 
outrun  the  average  child.  I  hope  such  schools 
are  useful  and  never  harmful,  but  if  you  put 
the  slow  and  rapid  memorizers  at  shop-work 

82 


A  DEFRAUDATION  OF  YOUTH 

or  field-work  together,  you  shall  find  that  the 
precocity  will  disappear — wherefore  it  is  a 
question  whether  lightning  memories  are  worth 
much,  and  whether  those  who  possess  them 
ought  to  be  called  super-boys  and  super-girls. 

There  are  special  schools  for  backward  chil- 
dren, which  are  much  to  be  commended.  But 
the  backward  children  (unless  they  have  actual 
brain  defects)  sometimes  cease  to  be  such  the 
moment  you  set  them  to  learning  by  doing 
something,  as  in  the  field  or  in  a  shop  with 
tools. 

There  are  outdoor  schools  for  sickly  and 
weakly  children,  especially  those  having  tuber- 
culosis of  the  glands  and  bones,  otherwise 
scrofula.  Most  large  cities  have  one  or  more 
such  schools,  some  of  them  on  the  roofs  of 
school  buildings.  They  are  in  the  highest 
degree  useful,  but  they  are  mostly  designed  for 
the  younger  children.  They  help  on  the  conva- 
lescence of  many  of  the  pupils  and  give  them  a 
good  start  in  life. 

But  for  the  considerable  class  of  young  peo- 
ple for  whom  this  paper  is  a  plea,  very  little  has 
been  done ;  a  great  deal  ought  to  be  done,  and 
it  is  not  difficult  to  do.  You  could,  but  you 
ought  not  to,  create  schools  and  colleges  spe- 
cially for  them.  If  they  could  have  a  fair 
chance  in  the  schools  and  colleges  extant,  it 
would  constitute  one  of  the  greatest  acts  of 
human  conservation. 

83 


A  DEFRAUDATION  OF  YOUTH 

What  a  vision  to  behold  if  the  majority  of 
schools  and  colleges  should  come  to  create 
scholars  in  the  business  of  life,  rather  than  in 
the  embellishments  of  a  luxury  that  few  of 
them  can  ever  have!  It  would  be  the  fore- 
shadowing of  a  real  millenium! 


84 


A  Presentation  Address 


A  Presentation  Address* 


This  is  one  of  a  series  of  pleasant  occasions 
that  have  attended  the  growth  and  metamor- 
phosis of  this  school  for  nearly  a  third  of  a 
century. 

Each  one  has  marked  some  accession  of 
value  in  its  progress  from  a  small  affair  with 
varied  aims  and  moderate  ambitions,  to  a 
concentration  of  effort  on  the  most  ambitious 
plans  for  the  selection  and  excellence  of  the 
few.  Sometimes  the  acquisition  has  been  a 
material  one,  as  of  buildings,  grounds  and 
tools ;  sometimes  it  has  been  spiritual  and  intel- 
lectual. Today  we  welcome  both  forms. 

The  changes  in  the  institution  have  come 
through  a  process  of  elimination  of  the  casual 
and  easy — designed  for  the  many;  and  of  the 
engrafting  upon  it  of  the  more  difficult,  the 
more  costly — and  ultimately  the  more  potent, 
for  the  few  who  can  measure  up  to  its  require- 
ments. 

And  the  most  telling  addition  of  all  has  been 
the  deliberate  movement  toward  systematic  re- 


*Dedication  of  the  Norman  Bridge  Laboratory  of  Physics, 
California  Institute  of  Technology,  Pasadena,  January  28, 
1922. 

87 


A  PRESENTATION  ADDRESS 

search — otherwise  the  search  for  additions  to 
the  knowledge  of  the  world. 

We  are  gathered  here  to  take  note  of  the 
latest  material  addition  to  the  equipment,  as 
well  as  the  latest  spiritual  and  intellectual  acces- 
sion. This  laboratory  is  undoubtedly  a  long 
step  toward  an  ideal  outfit  for  teaching,  and 
for  the  research  that  is  in  the  greatest  demand 
at  this  time.  But  no  man  can  guess  what  new 
facilities  will  be  needed  within  a  few  years, 
for  novel  lines  of  research  not  now  even 
thought  of. 

The  growth  of  knowledge  comes  step  by 
step ;  sometimes  the  steps  are  short,  frequent, 
and  strictly  progressive ;  at  other  times  they 
are  long,  infrequent,  and  so  radical  that  one 
step  may  require  the  recasting  of  a  whole  sci- 
ence. A  hundred  such  instances  in  the  past 
stare  us  in  the  face,  each  one  having  sent  a  lot 
of  the  old  apparatus  to  the  scrap-heap.  Such 
may  some  day  be  the  fate  of  half  the  apparatus 
of  this  laboratory.  If  and  when  it  comes  it 
must  be  welcomed;  if  it  will  mean  the  achieve- 
ment of  vital  economies  for  mankind  the 
exchange  will  be  profitable,  and  the  trade  will 
be  a  good  one.  And  you  will  then  probably 
buy  new  and  better  apparatus,  and  go  on  with 
your  research,  but  with  new  angles  and  for 
newly  discovered  purposes. 

It  was  to  be  expected  that  such  an  expansion 
and  elaboration  in  exacting  education  would 

88 


A  PRESENTATION  ADDRESS 

occur  here,  on  this  hill — and  with  some  such  an 
institution  as  this.  For,  eons  ago  Providence, 
by  the  forces  of  the  stars,  made  it  certain  that 
some  day  there  would  be  here  a  great  commun- 
ity of  people,  capable  of  such  achievements  as 
this  movement  represents,  provided  the  land 
could  be  blessed  with  a  stable  and  enduring  gov- 
ernment. Ages  ago  it  was  foreordained  to  hap- 
pen ;  it  was  bound  to  come,  and  come  here — but 
with  the  indispensable  peace-protecting  and 
industry-protecting  government. 

Millions  of  years  ago — yesterday  morning  it 
was,  by  the  calendar  of  geologic  time — the 
nearby  mountains  were  lifted  up  by  the  buck- 
ling forces  from  below ;  and  the  off-shore  cur- 
rents of  the  more  distant  sea  were  then 
ordained  to  flow  southward,  and  to  flow  cold. 
Then  it  was  that  the  good  luck  of  the  low  lati- 
tude and  the  right  width  of  the  low  littoral, 
made  it  as  sure  as  fate  that  here  would  be  a 
wholesome  climate,  highly  conducive  to  work 
and  achievement,  and  that  superior  people 
would  one  day  come  hither  in  great  numbers 
— given  always  a  protecting  government. 

The  influence  of  the  mountains  and  the  ocean 
—the  shape  and  height  of  the  mountains  and 
the  currents  of  air  and  sea;  the  width  of  the 
plain  between,  and  the  fortunate  latitude,  have 
made  an  ideal  atmosphere  on  one  lofty  spot  on 
the  mountain  for  astronomical  study — which 
study  in  our  time  has  been  realized  in  astound- 

89 


A  PRESENTATION  ADDRESS 

ing  fashion.  In  that  day  those  forces  also 
created  here  a  multitude  of  engineering  prob- 
lems that  were  good  for  instruction,  and  for  a 
challenge  to  research  by  some  far-off  generation 
of  men.  We  stand  today  in  the  mid-period  of 
that  generation ;  and  it  would  be  a  shame  for  us 
to  fail. 

Providence  seems  to  have  guided  the  human 
hands  that  have  developed  this  institution  as  it 
is  today.  Really,  it  was  a  late  discovery  of  a 
few  people  that  nature  had  provided  here  the 
best  conditions  to  make  it  the  logical  spot  for 
a  movement  of  this  kind. 

The  first  inspiration  came  to  Amos  Throop, 
a  rugged,  great  soul  with  a  far-reaching  vision, 
who  had  been  enticed  here  by  the  natural  ad- 
vantages for  health  and  comfort.  He  knew 
how  great  these  advantages  are,  and  he  knew 
that  before  many  decades  there  would  come 
about  in  this  Southland  the  rapid  growth  of 
cities  and  the  beehive  of  activity  that  we  now 
see  all  about  us.  He  saw  that  this  community 
needed  and  deserved  the  best  advantages  of 
education  and  power.  No  such  advantages  had 
been  provided  for  Pasadena.  He  had  an  ideal 
of  a  school  to  equip  men  to  do  things  as  well  as 
to  think  and  remember.  His  life  had  been 
keyed  to  practical  in  contradistinction  to  scho- 
lastic achievements.  So  he  founded  a  Poly- 
technic Institute,  and  gave  it  all  the  money  he 
had.  By  the  measures  of  today  the  gift  was 
90 


A  PRESENTATION  ADDRESS 

not  large,  but  it  was  greater  than  Mr.  Car- 
negie or  Mr.  Rockefeller  ever  gave — for  it  was 
all  he  had.  And  he  did  what  many  givers  of 
money  forget  to  do :  he  gave  himself  with  his 
gifts. 

From  that  laudable  beginning,  this  school  of 
high  college  grade  has  grown.  Now  it  sum- 
mons from  afar,  and  ofttimes  invents,  tools  for 
its  art  unheard  of  before ;  and  it  calls  from  the 
ends  of  the  earth  the  ablest  experts  into  its 
faculty.  Moreover,  men  famous  in  science 
come  here  to  pursue  further  research  with  its 
facilities,  under  the  inspiration  of  its  work,  and 
in  the  midst  of  its  many  advantages. 

With  all  this  development,  the  Institute  has 
never  departed  from  the  original  ideals  of  Mr. 
Throop  ("Father  Throop",  as  he  was  lovingly 
called)  that  it  must  in  the  highest  degree  possi- 
ble give  an  education  that  shall  fit  men  to  do 
things  in  this  rushing  world  of  useful  achieve- 
ments— and  a  new  civilization. 

The  new  laboratory  is  the  latest  step  in  this 
practical  direction,  but  by  no  means  the  last 
step.  It  is  being  equipped  with  all  the  practical 
things  its  designers  could  think  necessary — 
but  no  human  mind  can  foresee  what  new 
machinery  may  be  needed  on  tomorrow — or 
some  other  morrow.  In  this  particular,  the 
end  is  not  yet ;  and  the  equipment  will  never  be 
finished.  It  will  always  be  growing  and 
changing. 

91 


A  PRESENTATION  ADDRESS 

Another  inspiration  came  out  of  a  search  for 
a  good  place  for  a  Carnegie  Observatory  for 
the  study  of  the  sun  and  other  stars.  Should 
it  be  located  here  or  across  the  sea;  or  across 
the  equator?  It  must  be  put  in  the  best  place 
— for  millions  of  money  were  sure  to  be  spent 
upon  it.  The  incomparable  Director  of  that 
work  soon  demonstrated  the  natural  advantages 
of  Mt.  Wilson  for  the  observatory.  More 
than  that,  as  this  region  bristles  with  scientific 
problems  and  interrogation  points,  he  saw  that 
here  was  the  place  of  election  for  a  great 
scientific  school  of  the  future.  It  not  only 
belonged  here,  but  it  would  be  a  wholesome 
neighbor  to  the  Observatory.  Then  it  was 
that  Dr.  Hale  consented  to  become  a  Trustee 
of  this  corporation,  on  the  condition  that  the 
Board  should  fix  a  standard  for  the  school, 
a  little  higher  than  that  of  any  other  then  in 
existence.  The  Board,  under  the  enthusiastic 
leadership  of  the  then  President,  Dr.  Scherer, 
promptly  accepted  the  challenge ;  and  it  has. 
I  believe,  kept  its  promise,  and  maintained  the 
condition. 

But  the  plans  for  this  higher  emprise  could 
not  have  been  carried  out,  but  for  the  vision, 
faith  and  unfalteringness  of  the  Chairman  of 
the  Board,  Mr.  Fleming.  His  wisdom  has, 
if  possible,  exceeded  his  determination;  he  has 
asked  for  other  large  gifts  and  got  them; 
and,  like  the  true  soldier  he  is,  he  has  led  the 

92 


A  PRESENTATION  ADDRESS 

way  by  making  larger  gifts  himself.  To  use 
a  colloquialism,  he  has  been  for  years  the  very 
"angel"  of  the  Institute.  He  does  more  good 
things,  and  talks  less  about  them,  than  anybody 
else — and  I  nominate  him  as  the  most  useful 
citizen  in  this  community. 

The  evolution  of  a  great  laboratory  is  an 
absorbing  subject — absorbing  both  in  interest 
and  money.  Two  years  ago  a  laboratory  of 
the  physical  sciences  became  a  vital  need  of  the 
Institute,  if  it  were  to  go  on  in  its  progress 
without  halting.  It  required  a  large  expendi- 
ture of  money.  Some  folks  at  our  house,  who 
had  watched  the  growth  of  this  movement 
from  its  beginning — and  helped  through  its 
first  two  decades  and  more — had  for  long  ex- 
pected to  do  something  more  substantial  to- 
wards its  perfection  than  they  had  done  before. 
Of  course  they  knew  of  this  urgent  need  and 
opportunity.  But  they  were  unable  to  see  how 
they  could  provide  even  a  small  laboratory 
without  losing  so  much  time  that  opportunities 
and  treasures  of  the  first  order  were  likely  to 
be  lost  before  the  building  could  be  completed. 
And  the  need  was  for  a  great  laboratory,  not 
a  small  one.  Then  a  new  light  dawned,  a  hint 
from  a  genius,  and  the  laboratory  began  to 
take  form  as  a  reality. 

The  program  of  this  occasion  says  that  the 
presentation  of  the  laboratory  is  to  be  made  by 
the  donor.  It  ought  to  have  said  donors.  For 

93 


A  PRESENTATION  ADDRESS 

myself  and  Mrs.  Bridge,  some  personal  facts 
should  be  stated  here;  and  one  of  them  is  that 
I  appear  here  rather  under  false  pretenses. 
We  could  not  have  rapidly  provided  this  mag- 
nificent and  elaborate  structure  without  the 
influence  and  connivance  of  that  remarkable 
man  already  named,  the  wise  and  unselfish 
Chairman  of  the  Board  of  Trustees.  So,  con- 
structively he  is  in  very  essence  one  of  the 
donors.  Without  his  wisdom  and  faith,  this 
building  could  not  have  been  provided  in  time 
to  function  early,  and  early  to  embrace  the 
greatest  opportunity  the  institution  has  ever 
had.  And  as  I  am  speaking  in  the  presence  of 
— as  well  as  at — the  head  of  the  governing 
council  of  the  Institute,  who  is  also  the  Director 
of  the  Laboratory,  I  will,  at  the  moment,  spare 
his  embarrassment  by  merely  hinting  at  what 
that  opportunity  wras.  This  community  and 
the  educational  world  are  fast  finding  out  what 
it  was;  and  if  God  and  the  fates  spare  his  life, 
they  shall  in  good  time  realize  it  completely. 

For  myself,  I  beg  to  make  a  personal  explan- 
ation and  a  confession — wherein  may  appear 
the  evidence  of  the  amazing  vacillation  of  man. 
I  had  long  protested  that  my  name  should  not 
be  given  to  any  endowment  of  anything  that  I 
might  ever  make ;  I  protested  against  the  use 
of  it  on  this  laboratory  building;  and  the  argu- 
ments of  members  of  the  Board  and  other 
friends,  including  the  Director  of  the  Labo- 

94 


A  PRESENTATION  ADDRESS 

ratory  himself,  failed  to  move  me  in  this  par- 
ticular— until  I  found  that  the  vital  member  of 
my  own  household,  who  had  for  half  a  life- 
time helped  toward  this  opportunity,  was  in 
league  with  these  people — then  I  surrendered. 
And  I  am  ready  now  to  confess  to  one  comfort 
in  seeing  my  name  chiseled  over  the  chief  por- 
tal :  it  ought  to  tend  toward  discouraging  the 
public  from  longer  trying  to  impose  on  my 
name  a  final  ^  and  a  middle  initial ! 

As  to  the  material  contributions  toward  the 
building,  they  are  made  with  utter  gladness, 
with  the  knowledge  that  here  shall  develop  a 
great  center  of  education  and  research  that  will 
give  the  start  and  found  the  careers  of  many 
of  the  scholars  and  super-engineers  of  the 
future — and  make  life  easier  and  more  joyful, 
as  well  as  more  worth  living,  to  vast  numbers 
of  people — for  the  men  who  are  graduated  here 
will  carry  the  torch  to  others,  and  they  to  still 
others,  on  through  an  endless  succession.  Cer- 
tainly no  gift  of  mine  already  made,  or  that 
shall  hereafter  be  made  here,  can  possibly  be  a 
measure  of  my  faith  in  this  institution,  and  I 
have  not  for  years  had  any  official  connection 
with  it.  My  faith  in  it  is  greater  than  if  I  had 
a  hand  in  its  management. 

Finally  now,  and  in  behalf  of  the  donors  and 
all  the  friends  who  have  encouraged  this  con- 
summation— those  who  have  hoped  and  prayed 
for  it ;  those  who  have  planned  and  designed  it 

95 


A  PRESENTATION  ADDRESS 

and  watched  its  growth;  and  those  who  have 
devised  and  furnished  the  sinews  of  construc- 
tion that  have  made  its  walls  rise  into  being — 
in  behalf  of  all  these  and  in  their  name,  I  com- 
mend and  present  this  Laboratory  of  Physics 
— the  last  and  best  word  in  a  modern  workshop 
of  nature's  philosophy,  to  this  Corporation,  and 
to  you,  Dr.  Millikan,  its  Director — to  you,  sir, 
who  embody  in  your  person  the  new  spiritual 
and  intellectual  gift  that  comes  with  the  Lab- 
oratory. And  you  are  the  hope  and  sure  prom- 
ise of  the  future ! 


Ephraim  Fletcher  Ingal 
The  Man 


Ephraim  Fletcher  Ingals — 
The  Man* 

It  must  be  nearly  thirty  years  ago  that  as  Dr. 
Ingals  and  I  attended  together  the  funeral  of  a 
friend,  he  said  to  me:  "This  service  will 
get  around  to  you  and  me  by  and  by — soon 
enough."  Much  water  has  passed  over  the 
wheels  since  that  day  for  both  of  us.  And 
now — after  a  friendship  of  more  than  forty 
years — I  am  privileged  to  speak  here  of  his 
personality  and  life,  as  I  am  sure  he  would 
gladly  have  spoken  for  me  had  I  preceded  him. 

My  relations  with  him  began  when  we  joined 
a  group  of  young  men  who  entered  the  teach- 
ing staff  of  Rush  College  in  the  early  seventies 
of  the  last  century. 

Almost  from  the  first  that  group  advocated 
more  and  better  teaching  of  the  classes  and 
more  severe  conditions  of  admission  to  the 
College.  And  some  of  them  helped  finally  the 
affiliation  with  the  University  two  decades 
later.  Dr.  Ingals  led  all  the  rest  of  us  and 
exceeded  all  by  his  courage  and  faith  in  this 
movement. 


*An     address    delivered     at     the     Commencement    of    Rush 
Medical  College  of  the  University  of  Chicago,  June  12,  1918. 

99 


THE  MAN 

Only  two  of  that  group  of  young  men  now 
remain ;  and  they,  by  their  bewhiskered  gray- 
ness,  show  the  younger  generation  what  these 
last  are  coming  to.  Most  of  the  group  entered 
this  work  without  having  earned  an  academic 
degree,  and  Dr.  Ingals  was  one  of  the  majority. 
But  since  that  time  colleges  have  been  led,  in 
unguarded  moments,  to  decorate  some  of  these 
men  with  complimentary  degrees — myself 
among  the  number. 

They  had  the  optimism  of  their  years  and 
blood,  and  the  temerity  of  reformers.  They 
insisted  that  medical  education  in  this  country 
must  be  improved  with  pedagogy  in  general, 
and  that  premedical  education  must  become 
respectable,  which  it  was  not  with  most  col- 
leges at  that  time. 

Many  of  the  senior  teachers — grand  men  for 
their  day— opposed  anything  beyond  the  most 
slowly  developing  reforms.  They  held  to  the 
doctrine  of  conservatism,  and  feared  novelties 
that  meant  severity  in  conditions  of  admission 
and  graduation — for  that  would  be  sure  to 
reduce  the  classes  and  the  income — and  there 
was  no  other  income  but  that  from  student 
fees.  Those  were  the  days  of  the  so-called  pro- 
prietary medical  colleges  all  over  this  country. 

But  the  reforms  were  bound  to  come ;  many 
and  varied  influences  were  soon  at  work  to 
push  the  good  cause  forward.  Before  long 
some  momentum  was  gained,  then  speed  in- 

100 


THE  MAN 

creased;  and  finally  came  for  this  institution 
the  affiliation,  and  with  it  the  benefits  of  uni- 
versity standards  and  association,  and  the  in- 
spiring force  of  that  missionary  of  higher 
education,  the  President  of  the  University. 

It  was  the  old  story  of  the  ship  builders. 
Men  said  that  iron  ships  could  never  super- 
sede wooden  ships.  Their  children  said  that 
steel  ships  could  never  take  the  place  of  iron. 
Now  we  are  skeptical  about  concrete  ships — 
which  may  yet  displace  the  others.  Many  of 
us  declared  that  practical  flying  machines  were 
impossible,  but  American  ingenuity  and  petro- 
leum have  confounded  our  disbelief.  The 
progress  of  our  profession  in  forty  years  has 
outdone  the  airplane  in  wonder,  and  far  out- 
done it  in  beneficence. 

Dr.  Ingals  had  a  sort  of  preparation  for  life 
that  at  first  he  was  unable  to  appreciate.  It 
came  to  him  in  part  from  his  forbears  who  gave 
him  toughness  of  fiber,  clear  and  straight  think- 
ing, and  best  of  all,  the  determination  that  fitted 
him  to  tussle  with  a  lot  of  elements  which,  be- 
cause they  were  obstacles,  developed  in  him 
power  to  overcome  greater  ones. 

But  there  were  other  forces.  He  was  in  his 
youth  a  farmer,  and  learned  to  use  a  hundred 
different  farm  tools  and  utensils.  He  went 
through  a  great  rural  manual  training  school 
without  being  aware  of  it  or  of  its  value.  He 
had  learned  some  dozens  of  different  processes 

101 


EPHRAIM  FLETCHER  INGALS 

of  farm  work.  No  wonder  he  found  new 
devices  and  tools  easy  to  master  in  his  pro- 
fession. 

These  gifts  it  was  that  enabled  him  the  other 
day  to  finish  a  career  as  physician,  teacher, 
organizer,  citizen  and  neighbor,  which  his  fam- 
ily, his  friends  and  the  community  may  well 
be  proud  of. 

He  came  of  good  stock  from  far  back.  His 
people  were  stable,  thoughtful,  working  folk; 
and  he,  as  they,  came  up  through  industry,  fru- 
gality, temperance  and  self-respect.  He  early 
learned  the  value  of  a  dollar;  he  learned  that 
and  other  good  things  in  his  industrial  school 
of  life,  all  of  which  helped  to  save  him  from 
many  pitfalls  afterward. 

He  was  marked  for  success  from  the  start, 
and  those  who  knew  him  as  a  young  man,  knew 
he  would  rise  if  his  life  and  health  were 
spared.  His  education  was  good,  if  not  classi- 
cal, and  it  was  a  continuing  process  for  half 
a  century.  Some  of  it  was  gained  against  a 
painful  handicap  that  for  several  years  threat- 
ened him  with  blindness. 

He  had  an  ambition  to  succeed  by  his  own 
efforts — he  had  what  we  call  grit  and  tenacity ; 
and  these  traits  colored  his  entire  life. 

He  had  decided  opinions  on  many  subjects 
which  he  often  asserted  with  positiveness,  but 
he  neither  shouted  nor  paraded  them.  He 
spoke  in  gentle  tones  which  rather  added  to 

102 


THE  MAN 

his  impressiveness.  At  times  he  may  have 
appeared  to  some  as  rather  insistent  and  un- 
compromising— but  that  is  a  charge  that  is  laid 
at  the  door  of  a  host  of  successful  men  who 
have  helped  to  move  this  human  world  forward. 

He  had  a  sense  of  humor,  but  it  was  not  an 
intense  one.  He  enjoyed  but  rarely  told 
amusing  stories,  and  never  in  my  hearing  one 
that  he  could  not  tell  to  his  wife  or  his  daughter. 
And  I  never  heard  him  laugh  explosively  as 
many  men  and  women  do — often  on  slight  oc- 
casion. 

It  is  refreshing,  amid  the  grandiose  flare  that 
is  so  much  the  fashion  of  our  time — the  waste 
of  energy  in  spurts  of  ostentatious  effort,  to  see 
a  man  go  with  quiet  continuity  about  the  pur- 
poses of  his  life,  and  succeed  steadily,  and 
make  the  fewest  mistakes.  He  succeeded  by 
no  haphazard  process,  but  by  persistency  with 
thought,  strategy,  even  finesse — and  often  with 
compromise.  I  have  recently  re-read  some 
hundreds  of  letters  received  after  my  expatria- 
tion to  California  in  1891,  and  have  found  a 
large  bundle  of  them  from  Dr.  Ingals,  in  which 
he  described,  among  other  things,  negotiations 
in  the  interest  of  the  College.  Many  treat  of 
his  hopes  and  plans  for  affiliation,  and  describe 
minutely  many  conferences,  and  discussions  of 
ways  and  means,  and  emphasize  the  mutualness 
of  the  interests  of  the  College  and  University. 
No  man  could  have  been  more  consistent  or 

103 


EPHRAIM  FLETCHER  INGALS 

persistent  in  such  a  constructive  purpose. 
These  letters  are  a  fine  exhibition  of  continuing 
friendship  and  of  personal  philosophy. 

Few  men  have  ever  more  effectively  than  he 
programmed  their  lives.  His  hours  were  or- 
ganized for  efficiency;  and  for  many  years  his 
working  day  began  when  his  neighbors  were 
still  snoozing  in  bed,  and  before  the  sun  was 
in  sight.  He  more  often  saw  the  sun  rise  than 
any  other  doctor  I  ever  knew.  The  Congress 
has  passed  a  daylight  saving  law  to  effectuate 
this  economy  by  the  fiction  of  moving  the  clock 
forward  an  hour.  Of  course,  the  more  nat- 
ural way  would  have  been  for  the  people  to 
resolve  to  get  out  of  bed  an  hour  earlier;  but 
they  could  not  be  trusted  to  do  that,  so  the  Con- 
gress took  advantage  of  their  fixed  habits  and 
saved  them  by  the  trick  of  outraging  the  great 
time-keeper,  the  sun.  Dr.  Ingals  needed  no 
such  subterfuge  for  the  conservation  of  his 
energy. 

He  was  always  busy  at  something;  and  as 
he  worked  systematically  he  rarely  seemed  to 
be  in  a  hurry.  He  could  do  a  large  profes- 
sional business,  lecture  in  the  College,  attend  a 
hospital,  have  some  medical  writing  on  hand  all 
the  while — a  book  or  a  society  paper — attend 
to  his  secular  business ;  and  never  seem  to  be 
in  haste.  He  spoke  deliberately,  worked  and 
acted  rather  slowly ;  but  he  arrived.  It  is  a 
habit  that  vast  numbers  of  men  and  women 

104 


THE  MAN 

need  to  covet.  It  saves  energy  and  prolongs 
life. 

His  professional  work  was  always  recorded; 
it  was  not  trusted  to  the  treachery  of  memory, 
but  went  down  in  case  records  by  his  own  hand 
or  that  of  his  assistants.  Some  parts  of  these 
records  were  in  abbreviations  and  signs;  and 
often  they  were  in  several  handwritings,  but 
they  served  the  purpose.  Thus  his  work  was 
free  of  the  slovenly  hit-or-miss  faults  that  have 
been  so  common  among  doctors.  Moreover, 
his  records  were  the  basis  and  material  for  sta- 
tistics on  which  to  found  better  study  of  path- 
ology and  diagnosis,  and  for  better  treatment 
of  the  sick. 

In  1875  in  Chicago  two  medical  journals  (the 
Journal  and  the  Examiner)  were  united  into 
one,  and  named  the  Chicago  Medical  Journal 
and  Examiner.  It  was  under  the  nominal 
editorship  of  the  late  Dr.  Byford — the  real 
work  being  done  by  four  young  men  (Drs. 
Etheridge,  Hyde,  Hotz  and  Bridge)  who  took 
turns  in  getting  out  successive  numbers  of  the 
paper.  Fancy  a  monthly  publication  changing 
its  editor  with  every  issue  for  four  months  in 
succession — and  then  repeating  the  process 
over  and  over !  Of  course  it  was  sure  to  work 
badly ;  and  after  a  year  or  more  of  this  absurd 
program,  the  details  were  all  given  into  the 
hands  of  Dr.  Ingals  and  the  quartet  retired. 
He  did  the  work  in  a  painstaking  and  efficient 

105 


EPHRAIM  FLETCHER  INGALS 

manner  for  several  years.  Then  his  growing 
medical  practice  compelled  him  to  relinquish  it. 
He  gave  a  great  amount  of  time  to  this  serv- 
ice— but  it  was  not  wasted ;  for  it  fixed  in  him 
a  habit  of  writing,  a  critical  sense  in  the  use 
of  language,  that  gave  such  a  forceful  sim- 
plicity and  finish  to  his  style,  as  to  materially 
add  to  his  fame. 

He  was  a  superior  practitioner;  he  was  ex- 
ceptionally deft  in  his  operative  work,  and 
above  all  he  was  imperturbable.  He  was  never 
stampeded  by  the  accidents  or  surprises  of  a 
case  of  sickness  or  surgery.  What  a  gift  for 
a  doctor  to  have ! 

He  devised  numerous  instruments  and  oper- 
ative procedures.  And  some  of  these  were 
rather  startling.  As  I  have  seen  him  slide  in- 
struments through  the  larynx,  far  down  the 
trachea  into  the  larger  bronchi,  and  fish  out 
foreign  bodies  from  the  lungs,  I  have  thought 
of  the  lady  that  a  doctor  friend  used  to  tell  of, 
who  at  her  first  encounter  with  a  laryngoscope, 
asked  the  operator  how  far  down  into  a  human 
body  he  could  see  with  that  machine.  And 
he  replied  solemnly,  that  he  could  see  the  cane 
seat  of  the  chair  on  which  she  sat.  "Then," 
said  she,  "please  take  a  look  at  my  liver."  I 
am  not  certain  that  our  late  friend  was  not  that 
laryngologist. 

Dr.  Ingals  helped  to  redeem  the  reputation 
of  our  profession  in  the  business  world.  We 

106 


THE  MAN 

doctors  have  been  classed  with  preachers, 
artists  and  women,  as  generally  incapable  of 
business  judgment.  Our  business  failures  have 
been  advertised;  our  speculating,  skyrocketing 
ventures  that  came  to  grief  have  been  recounted 
and  exaggerated.  And  if  one  ever  made  a  sig- 
nal success  in  a  business  way,  it  was  attributed 
to  either  luck  or  shady  methods. 

But  professional  men  are  capable  of  business 
sense  and  honor ;  and  that  a  man's  chief  voca- 
tion is  the  study  of  the  human  body,  and  how 
to  prolong  its  life  and  lessen  its  sorrow  and 
pain — is  no  reason  why  he  may  not  observe 
the  business  world  about  him,  and  profit  by 
the  habits  of  men  who  make  successes  by  sound 
methods  and  with  a  minimum  of  failures. 
This  Dr.  Ingals  did  and  he  succeeded.  And, 
too,  he  proved  that  wealth  is  not  discreditable 
provided  you  do  not  make  a  bad  use  of  it ;  and 
he  had  the  sense  to  avoid  the  besetting  weak- 
ness, the  ofttimes  fashion  of  riches,  which  is 
the  ostentatious  display  of  them. 

He  was  for  many  years  the  comptroller  of 
Rush  College  and  held  us  all  rigidly  to  the  rules 
and  the  budget.  He  confirmed  safe  business 
methods  for  the  institution,  that  have  com- 
mended it  to  the  faith  of  the  public,  and  made 
more  easy  the  raising  of  the  vast  sum  of  money 
gathered  together  recently  for  the  creation  of  a 
greater  center  of  medical  study  under  the 
wings  of  the  University.  He  deplored  waste 

107 


EPHRAIM  FLETCHER  INGALS 

whether  in  public,  in  institutional  or  personal 
affairs — and  that,  when  not  carried  too  far,  is 
a  good  sort  of  caution  for  a  guide. 

His  success  was  not  fortuitous;  he  was  no 
accident.  His  life  was  planned  with  the  most 
deliberate  method,  and  in  a  way  to  be  a  type 
and  model  for  youths  in  general,  and  especially 
for  all  young  doctors  who  have  courage  and 
will-power.  They  need  these,  as  they  need  to 
be  stoics  when  the  peltings  of  the  storms  of  life 
come,  and  when  pain  strikes  the  mortal  body. 
Then  especially  they  need  to  have  power  to 
exteriorize  their  minds,  and  to  force  themselves 
to  work  on  and  on.  This  he  illustrated  always, 
and  with  astounding  heroism  through  many  of 
his  later  months,  when  he  knew  that  the  pains 
he  suffered  forespoke  for  him  a  death  that 
might  come  at  any  moment.  Yet  he  worked  on, 
amused  himself  as  he  could,  played  golf,  enter- 
tained his  friends,  and  wrote  for  his  brothers 
an  account  of  his  case  with  a  discussion  of  the 
disease — which  was  read  at  the  Institute  of 
Medicine  a  month  before  he  left  us. 

He  did  more  than  this.  When  our  nation 
declared  war,  he  was  anxious,  despite  his  in- 
firmity, to  have  some  part  in  the  struggle,  and 
so  he  accepted  a  commission  in  a  corps  of  medi- 
cal men  advisory  to  the  Surgeon-General. 
And  the  most  precious  picture  of  him  that  we 
have  is  not  in  a  professorial  gown  (which  al- 
ways much  became  him)  but  in  the  uniform  of 

108 


THE  MAN 

a  captain  in  an  army  engaged  in  the  holiest  war 
ever  waged.  He  has  there  his  usual  look  of 
quiet  firmness,  and  the  appearance  of  a  man  of 
half  his  years.  He  was  glad  of  this  opportu- 
nity to  help,  if  only  in  a  quiet  way,  toward  the 
one  inevitable,  awful  consummation  in  this 
world  fight — as  he  was  proud  that  his  son  was 
accepted  in  the  corps  that  involves  the  most 
skill  and  hazard. 

Dr.  Ingals  was  not  a  genius.  We  do  not 
need  geniuses,  and  could  get  on  for  a  few  cen- 
turies without  any  more  of  them;  for  they 
usually  have  unstable  nerves  and  mental  pow- 
ers. But  he  had  a  genius  for  building  on  a 
good  foundation .  and  he  knew  a  good  founda- 
tion. He  had  large  talents  which  he  neither 
buried  nor  kept  idle. 

He  was  not  an  orator.  He  could  never  have 
been  a  spellbinder,  nor  did  he  desire  to  be. 
Heaven  spare  us  from  most  such,  and  from 
those  who  think  they  are  orators.  He  told  his 
message  in  plain  words  that  were  understood, 
and  some  of  the  things  he  said  and  did  were 
eloquent  without  his  knowing  it. 

He  did  not  pose  as  a  literary  man,  yet  he 
materially  added  to  the  solid  literature  of  the 
profession  by  some  standard  books  of  perma- 
nent value,  and  by  a  swarm  of  brochures  of  like 
excellence — and  all  written  in  faultless  English. 

He  was  the  last  man  to  emphasize  his  own 
virtues,  but  his  life — professional  and  per- 

109 


EPHRAIM  FLETCHER  INGALS 

sonal — was  founded  on  the  ethics  that  belong  to 
a  gentleman,  namely,  a  due  regard  for  the  rights 
and  feelings  of  others.  This  is  the  basis  also 
of  the  best  ethics  of  nations.  A  Mexican  In- 
dian, Benito  Juarez  by  name,  years  ago  gave  an 
apt  definition  of  peace  when  he  said :  "It  is 
the  condition  where  each  people  is  careful  to 
respect  the  rights  and  feelings  of  every  other 
people."  This  is  a  doctrine  for  men  and 
nations  in  all  times.  And  it  is  the  rule  especi- 
ally for  us  in  this  perturbed  and  anxious  year 
of  grace. 

Dr.  Ingals  had  the  qualities  of  true  great- 
ness— greater  because  they  were  unconscious — 
and  his  career  justified  his  qualities.  We  need 
more  men  of  his  stamp. 

The  material  and  moral  fruits  of  his  pilgrim- 
age came  to  him  naturally  and  as  a  matter  of 
course,  and  came  with  no  shadow  of  sordid- 
ness  ;  they  were  glorified  by  having  been  both 
earned  and  deserved.  Beyond  all  these,  his  in- 
comparable wife,  who  was  in  all  the  years  his 
greatest  help  and  strength,  and  next  to  her 
their  four  stalwart  children,  were  his  greatest 
rewards  of  all. 

In  the  ripeness  of  his  years  his  journey 
halted.  And  with  all  travail,  in  the  end  he 
could  say  with  Joseph  of  old,  who  gave  him  his 
name  of  Ephraim :  "For  God  hath  made  me 
fruitful  in  the  land  of  my  affliction." 

110 


Henry  Bachman  Stehman 


Henry  Bachman  Stehman 

On  February  17,  1918,  there  died  in  Pasa- 
dena, California,  a  modest,  gentle,  great  man, 
whose  career  as  citizen,  physician  and  philan- 
thropist was  unique. 

He  was  born  in  1852;  was  graduated  from 
Lebanon  Valley  College  in  1873 — receiving 
there  later  the  A.M.  degree. 

He  was  a  student  at  the  Universities  of  Leip- 
sic  and  Brussels  from  1873  to  1875 ;  and  he 
received  the  degree  in  medicine  from  Jeffer- 
son Medical  College  in  1877.  After  this  he 
served  an  interneship  in  Blockley  Hospital. 

In  1881  he  married  Miss  Elizabeth  Miller. 
He  became  superintendent  of  the  Presbyterian 
Hospital  of  Chicago  in  1884,  and  so  continued 
until  1899,  when  his  health  broke  down  and  he 
resigned  and  moved  to  Pasadena. 

He  never  completely  recovered ;  but  he  got 
better,  and  before  long  began  some  profes- 
sional work,  which  he  continued,  under  the 
handicap  of  physical  suffering,  until  shortly 
before  his  death — and  he  died  the  most  useful 
citizen  of  the  town. 

He   was   never   content   to   be   simply   and 

113 


HENRY  BACHMAN  STEHMAN 

merely  a  practising  physician,  but  his  avoca- 
tions in  philanthropy,  public  benefit  and  reli- 
gion engaged  his  mind  and  heart  constantly. 
He  was  a  man  of  broad  and  sane  vision,  and 
the  work  he  undertook  he  usually  accom- 
plished. He  had  a  constructive  mind  and  a 
genius  for  organization,  which  had  scope  in 
two  hospitals — one  in  Chicago  and  one  in 
Pasadena — the  building  of  a  great  church  in 
Pasadena  (of  whose  Finance  Committee  he 
was  Chairman)  and  finally  in  a  monument  to 
his  zeal  for  service,  La  Vina  (The  Vineyard), 
a  sanatorium  for  tuberculosis,  situated  to  the 
northwest  of  Pasadena. 

As  a  hospital  manager  he  was  superb,  and  in 
procuring  funds  and  endowments  for  hos- 
pitals he  was  something  of  a  genius.  The 
Presbyterian  Hospital  received  through  him 
many  gifts — endowments  of  beds,  wards  and 
rooms,  and  bequests  of  large  amounts. 

He  chiefly  designed  the  interiors  of  several 
buildings  of  the  Pasadena  Hospital  and  he 
assisted  in  securing  large  gifts  for  this  institu- 
tion. 

La  Vina  (Vinya)  was  his  greatest  work. 
On  a  farm  near  the  mountains  have  arisen  some 
eighteen  buildings  for  the  housing  of  a  hundred 
patients.  The  farm  and  the  buildings,  and  all 
their  belongings,  have  been  the  willing  gifts  of 
those  who  believed  in  the  man  and  his  work. 

It  was  his  ambition  to  create  here  a  haven  of 

114 


HENRY  BACHMAN  STEHMAN 

rest  and  care  for  a  few  of  the  many  consump- 
tives who  walk  the  streets  as  long  as  they  can — 
and  walk  in  loneliness  and  desolation.  And 
this  he  nobly  did. 

For  ten  years,  in  the  midst  of  an  exacting 
practice  of  medicine,  he  gave  himself  to  this 
service  as  a  labor  of  love,  refusing  all  material 
rewards  of  any  kind — even  declining  gifts  for 
his  personal  comfort  and  relief  in  this  work. 

While  in  Chicago  he  was  for  eleven  years  a 
successful  teacher  in  Rush  Medical  College, 
finally  as  Assistant  Professor  of  Gynecology. 
He  was  an  expert  diagnostician,  and  a  resource- 
ful surgeon.  He  had  the  fine  art  of  helping 
the  sick  without  irritating  them. 

He  had  a  genius  for  raising  money  for  a 
good  cause,  and  he  did  it  without  annoying 
people.  He  rarely  asked  for  money  directly; 
rather  his  friends  and  acquaintances  enthused 
with  him  over  what  money  could  do  for  a  good 
cause — and  the  money  came  without  being 
asked  for. 

His  religion  he  took  more  seriously,  and  with 
less  parade  than  any  other  man  I  ever  knew. 
His  relations  with  others  were  always  kindly, 
unselfish  and  helpful.  His  purposes  in  life 
were  too  serious  for  him  to  waste  time  and 
energy  over  trifles;  these  he  took  with  rather 
amused  philosophy  that  saved  him  from  the 
harm  of  irritation.  The  power  of  his  unob- 
trusive personality,  like  a  rich  perfume,  touched 

115 


HENRY  BACHMAN  STEHMAN 

the  spirits  of  those  about  him  for  their  strength 
and  comfort. 

His  life  was  consecrated  to  the  weal  of  the 
sick  and  needy  of  all  classes,  of  all  religions 
and  no  religion.  He  respected  the  sincere 
opinions  of  others,  on  any  and  all  subjects;  he 
was  never  captious  or  disputatious;  he  was 
beloved  of  all  who  knew  him  and  of  him.  And 
in  his  final  protracted  agony,  he  had  the  sym- 
pathy and  prayers  of  the  churches  of  all  the 
religious  orders  in  the  city,  and  of  the  com- 
munity in  general. 


116 


On  the  History  of  Oil 


On  the  History  of  Oil* 

For  many  centuries  beds  of  a  hydrocarbon 
called  asphaltum  have  been  found  in  numerous 
places  on  the  surface  of  the  earth.  Before  re- 
corded history  began,  this  substance  was  used 
in  the  arts  and  industries  in  a  small  way,  for 
waterproofing  and  for  sticking  things  together. 
It  has  come  in  our  time  to  be  used  in  enormous 
quantities,  largely  for  paint,  waterproofing, 
roofing,  pavements  and  road-making. 

Likewise  in  numerous  places  in  many  coun- 
tries little  oozings  or  seepages  of  petroleum 
(also  a  hydrocarbon),  have  been  known  for 
centuries,  even  from  long  before  the  Christian 
era. 

It  was  a  long  time  before  it  crept  into  the 
dull  brain  of  man  that  the  asphalt  is  petroleum, 
which  has  lost  by  evaporation  its  lighter  prod- 
ucts, and  become  hard.  That  fact  means  that 
seepages  of  oil  must  have  gone  on  continuously 
for  milleniums  of  time,  for  some  of  the  as- 
phaltum beds  are  deep,  broad  and  very  hard. 

In  America  petroleum  was  mainly  a  curios- 
ity for  over  a  century.  It  was  used  in  minute 
quantities  as  medicine  (for  some  imagined 

•Read  before  the  Chicago  Literary  Club,  November  1,  1920. 

119 


ON  THE  HISTORY  OF  OIL 

quality  it  does  not  possess),  for  illumination, 
and  perhaps  occasionally  for  heat.  Finally 
some  one  conceived  the  idea  of  drilling  holes 
in  the  ground  near  the  seepages  in  the  hope  of 
getting  more  oil.  He  succeeded — then  drill- 
ing became  common;  the  fashion  grew.  That 
was  within  the  memory  of  many  people  now 
living.  For  the  past  sixty  years  petroleum 
has  had  a  rapidly  developing  career  of  power 
and  usefulness,  until  now  it  is  more  widely 
used  and  needed  than  any  other  substance  (not 
food),  with  the  possible  exception  of  iron  and 
coal.  It  has  become  responsible  for  vast  new 
industries  all  over  the  earth,  and  it  has  changed 
our  civilization,  as  it  has  revolutionized  the 
commerce  and  the  warfare  of  the  thinking 
world.  We  are  in  a  petroleum  age,  as  the 
world  has  for  long  had  a  coal  age  and  an  iron 
age,  both  of  which  changed  the  civilization  of 
the  race. 

The  drilling  of  oil  wells,  the  carrying  of  the 
oil  by  pipe  lines,  and  its  distillation  into  numer- 
ous products  for  use  in  commerce,  have  become 
and  constitute  one  of  the  great  industries  of  all 
time.  Vast  fortunes  have  been  made  out  of 
it — a  few  only;  the  majority  of  investors  in  oil 
have  made  little.  Like  mining  for  gold  and 
silver,  so  in  mining  for  oil — for  it  is  mining — 
the  majority  fail ;  the  minority  succeed,  and  a 
few  succeed  greatly. 

Petroleum  has  been  found  in  many  countries, 

120 


ON  THE  HISTORY  OF  OIL 

and  will  probably  be  found  in  many  regions 
only  dreamed  of  at  present.  The  stuff  is 
generally  struck  in  quantities  from  a  few  hun- 
dred to  over  four  thousand  feet  below  the 
surface ;  and  the  accumulated  hydrocarbon  gas 
mixed  with  the  oil  (and  clearly  a  product  of  it) 
has  sometimes  attained  such  a  pressure — up  to 
1000  Ibs.  to  the  square  inch — that  when  the 
drill  penetrates  the  reservoir  of  oil,  the  gas  and 
oil  gush  out  with  great  force,  throwing  tools 
many  feet  into  the  air  and  even  bringing  up  the 
casing  out  of  the  well.  This  causes  vast  havoc 
at  times,  and  great  loss  of  oil — both  increased 
if  perchance  the  gas  takes  fire.  Then  it 
requires  genius  energy  and  large  resources  to 
put  out  the  fire,  and  shut  off  the  flow  of  oil. 
Sometimes  this  feat  cannot  be  done,  and  the 
well  must  be  allowed  to  burn  and  flow  itself 
out,  often  lasting  for  many  weeks. 

The  first  production  of  some  of  these 
gusher-wells  is  fabulous — in  one  instance  it 
was  260,000  barrels  a  day  by  actual  measure- 
ment ;  and  the  stream  of  oil  rose  500  feet  into 
the  air,  as  shown  by  triangulation.  The  high 
production  of  a  well  usually  runs  down  rapidly 
from  the  first,  and  after  a  few  weeks  or  months 
reaches  a  moderate  production,  which  may  be 
maintained  for  a  long  time,  a  dozen  years  in 
many  cases,  occasionally  a  quarter  of  a  century. 
These  long-lived  wells  usually  require  to  be 
pumped  after  a  few  months  or  years. 
121 


ON  THE  HISTORY  OF  OIL 

The  oil  in  many  American  fields  is  found  in 
saturated  beds  of  sand  of  varying  thickness 
(sometimes  hundreds  of  feet  thick).  These 
sand  beds  are  underlaid  and  overlaid  by  hard 
shale  or  other  rock  formation.  These  beds 
extend  laterally  sometimes  for  many  miles — 
often  nearly,  but  not  quite,  level.  More  or 
less  of  the  sand  comes  out  of  the  wells  with 
the  petroleum,  in  some  instances  to  the  extent 
of  hundreds  of  tons ;  this  piles  up  in  the  large 
sump-holes  made  by  the  side  of  the  derrick  to 
receive  the  oil. 

Sometimes  two  or  three  beds  of  oil  sand  are 
known  to  exist  superimposed  one  above  the 
other;  there  may  be,  and  probably  in  certain 
fields  are,  more  than  three  such  layers  situated 
beyond  the  reach  of  the  longest  drill  machinery. 
These  sand  beds  are  separated  from  each  other 
by  hundreds  of  feet  of  hard  shale,  which 
usually  prevents  any  movement  of  oil  from  one 
sand  layer  to  another.  But  earthquakes  may 
crack  the  shale  and  rock  which  separate  the 
sand  layers ;  then  the  oil  might  leak  through  the 
cracks,  and  would  if  the  pressure  were  greater 
in  one  layer  than  in  another,  and  might  ulti- 
mately be  found  miles  away  from  its  original 
abode.  The  surface  seepages  probably  flow 
through  such  earthquake  cracks.  Like  water, 
the  oil  travels  in  the  direction  of  least  resist- 
ance, and  it  is  certain  that  some  oil  deposits 
have,  through  the  millions  of  years  since  they 

122 


ON  THE  HISTORY  OF  OIL 

were  formed,  occupied  two  or  more  widely 
separated  locations.  As  a  result  of  such 
changes  of  location  of  oil,  there  are  mountains 
of  hidden  and  exposed  shales — of  a  bluish-gray 
color — more  or  less  saturated  with  invisible 
oil  that  was  absorbed  from  previously  existing 
oil  deposits —  and  where  no  tangible  petroleum 
may  have  existed  for  a  million  years.  The 
petroleum  may  some  decades  hence,  be  profit- 
ably roasted  out  of  these  shales  for  commerce 
— after  the  easy  oil-mining  is  done  with. 
There  are  a  few  shale  distillation  works  that 
are  now  operating,  but  not  with  much  profit, 
except  where  transportation  charges  and  con- 
ditions protect  them. 

Anyone  unfamiliar  with  the  subject  can  test 
a  shale  for  oil  by  the  simple  process  of  drop- 
ping a  piece  of  it  as  large  as  a  bean  into  a  large 
test  tube,  and  holding  this  over  a  flame.  If  oil 
is  present,  it  will  soon  blacken  the  inside  of  the 
test  tube  and  produce  a  sputtering  sound,  with 
a  distinct  odor  of  petroleum. 

In  Mexico  and  other  regions  the  oil  is  mostly 
in  non-sand  formations — so  that  a  well  may 
produce  millions  of  barrels  of  oil  (70,000,000 
in  one  case),  without  a  bushel  of  sand  or  other 
debris. 

Oil  producers  naturally  develop  first  their 
largest  yielding  fields.  Nobody  will  hunt  for  a 
small  pumping  well  when  he  can  get  a  gusher ; 
and  gushers  have  been  found  in  many  fields  so 

123 


ON  THE  HISTORY  OF  OIL 

readily,  and  production  has  been  so  great,  that 
extravagance  and  wastefulness  have  shamefully 
beset  us. 

Water  fills  the  interstices  in  the  earth  crust 
down  for  hundreds  of  feet  below  the  surface. 
Petroleum  in  the  ground  is  always  lighter  than 
water,  and  as  the  oil  is  exhausted  water  takes 
its  place.  So,  in  a  way  it  may  be  said  that  the 
oil  rests  upon  the  water.  Sooner  or  later  the  oil 
wells  run  to  water.  That  means  that  water  is 
first  mixed  with  the  oil,  then  displaces  it 
entirely.  This  process  may  extend  through 
years ;  half  shutting-in  the  well  will  keep  back 
the  water  and  allow  more  oil  to  flow.  A  little 
water  does  not  spoil  the  oil  for  certain  pur- 
poses, as  for  burning  under  boilers.  If  the  oil 
is  light  in  gravity  it  may  be  easily  separated 
almost  completely  from  the  water,  and  then 
can  be  used  for  distillation,  or  for  any  purpose. 

The  phrase  "boring  an  oil  well"  is  often 
inaccurate;  for  most  wells  are  made  by  the 
pounding  of  heavy  drills,  attached  to  steel  rods 
in  a  combination  that  sometimes  weighs  a  ton 
or  more.  Steel  wire  rope  and  powerful 
machinery  lift  and  let  fall  these  pondrous 
drills  hour  after  hour,  night  and  day,  for 
months  together — with  occasional  interruptions 
to  clear  the  debris  out  of  the  hole,  to  add  new 
joints  of  the  lining  casing,  and  to  move  the 
whole  line  of  casing  up  and  down  to  make  sure 
that  it  is  movable  and  not  "frozen" — that  is, 

124 


ON  THE  HISTORY  OF  OIL 

not  stuck  fast.  The  driller  has  his  hand  on  the 
rope  or  its  attached  machinery  as  it  rises  and 
falls,  and  he  becomes  expert  in  telling  thus  by 
touch  the  behavior  of  the  drill,  as  it  pounds  the 
bottom  of  the  hole,  perhaps  a  half  mile  down 
in  the  earth  away  from  him.  An  Irish  laborer 
once  made  an  apt  remark  to  a  driller  on  seeing 
him  keep  his  hand  on  the  rising  and  falling 
cable.  He  said,  "Be  gorra,  an'  you  are  a 
long  way  from  your  worruk." 

In  a  minority  of  cases  the  rotary  or  revolv- 
ing drill  is  used,  of  course  in  earth  formations 
that  are  adapted  to  it.  This  is  a  more  rapid 
and  cheaper  method.  It  works  well  in  soft 
and  horizontally  stratified  formations;  not  in 
hard  or  upturned  strata. 

Oil  wells  cost  variously  from  ten  to  one 
hundred  thousand  dollars  each  (average  say 
$35,000),  including,  of  course,  the  metal  cas- 
ing that  lines  the  hole.  Tools  occasionally  are 
lost  in  the  well,  entailing  days  or  months  of 
time  in  attempts  at  fishing  them  out.  New 
grasping  tools  may  have  to  be  invented  for  the 
special  case,  and  the  greatest  amount  of  skill, 
ingenuity  and  long-headed  wisdom  are  often 
needed  to  extricate  the  tools ;  and  sometimes 
this  is  impossible,  and  the  well  must  be  aban- 
doned. 

Woe  be  to  the  well  and  the  drillers,  and  oft- 
times  to  the  treasury  of  the  owner  company,  if 
the  hole  becomes  crooked.  For  then  it  must 

125 


ON  THE  HISTORY  OF  OIL 

either  be  straightened,  which  requires  endless 
patience  and  rare  manipulative  skill  on  the  part 
of  the  driller,  or  the  well  must  be  abandoned, 
the  derrick  moved  some  distance  away,  and 
a  new  hole  started.  All  this  costs  money,  and 
a  great  deal  of  it. 

The  selection  of  the  place  to  drill  a  well  with 
prospect  of  rinding  oil  taxes  the  highest  skill 
and  knowledge  of  the  oil  prospector.  The  out- 
cropping of  sandstone,  the  cracking  of  which 
may  reveal  dark  stains  and  possibly  a  slight 
petroleum  odor;  the  contour  of  the  surface, 
and  knowledge  of  the  local  stratigraphy  all 
help,  especially  the  drilling  experience  of  near 
neighbors.  But  the  drill  itself  is  the  only  un- 
erring witness ;  and  dry  holes  are  extremely 
wasteful  of  money — and  prospectors  are  often 
poor. 

The  distribution  of  petroleum  under  the 
earth's  surface  is  extensive  over  the  globe.  It 
is  a  profitable  quest  in  many  States  and  coun- 
tries, and  it  is  found  in  small  and  unprofitable 
quantities  in  more  regions  probably  than  have 
commercial  findings.  Indeed,  except  in  the 
earliest  and  hardest  rocks,  it  is  altogether  prob- 
able that  you  could  find  at  least  traces  of 
petroleum  almost  anywhere  you  might  drill  to 
a  depth  of  say  a  mile  (5280  feet).  It  is  found 
in  profitable  amounts  in  many  high  altitudes — 
as  in  our  States  of  Montana  and  Wyoming, 
and  in  Canada.  This  shows  that  although  it 

126 


ON  THE  HISTORY  OF  OIL 

must  have  been  deposited  or  created  in  the 
same  way  as  on  the  lower  and  leveler  stretches, 
the  formations  have,  in  the  buckling  of  the 
earth's  surface,  been  lifted  several  thousand 
feet  into  the  air,  yet  not  all  the  oil  has  suc- 
ceeded in  leaking  away  from  perhaps  its  orgi- 
nal  bed — the  bed  and  all  the  rocks  about  it  have 
been  shoved  up  together,  without  losing  all 
their  precious  contents. 

Petroleum  has  been  mined  under  the  sea — 
near  the  shore  of  course ;  but  flecks  of  floating 
oil  on  many  oceans  have  proven  seepages  to 
exist  beneath  the  waters. 

A  subject  of  great  speculative  as  well  as 
practical  interest  is  the  conditions  and  method 
of  the  creation  of  the  petroleum  from  the  begin- 
ning. When,  how  and  where  was  this  product 
formed?  Several  theories  have  been  offered, 
and  hot  discussions  have  gone  on  about  them 
for  many  years.  The  chief  of  them  are :  ( 1 ) 
that  chemical  and  physical  conditions  deep  in 
the  earth  have  produced  the  hydrocarbon  sub- 
stances; and  (2)  that  the  oil  has  resulted  from 
the  dead  bodies  of  the  astounding  sea  fauna  of 
some  thirty  million  years  ago,  under  the  influ- 
ence of  time,  heat,  pressure,  and  probably  other 
physical  as  well  as  chemical  forces.  The  proof 
so  far  seems  to  tip  rather  in  favor  of  the  dead- 
fish  theory,  although  there  are  some  ingenious 
and  sound  arguments  in  favor  of  the  other  one. 

And  possibly  both  methods  are  responsible 

127 


ON  THE  HISTORY  OF  OIL 

for  the  occurrence  of  petroleum.  A  great 
amount  of  research  work  has  been  done  on  this 
problem,  and  a  library  of  papers  and  discus- 
sions about  it  has  accumulated.  More  than 
twenty  well  equipped  investigators  have  worked 
on  the  theory  of  inorganic  origin.  One  of  the 
most  fascinating  theories  is  that  of  Kizhner, 
based  (as  he  says  positively),  on  experiments 
which  show  that  petroleum  may  be  produced 
by :  "The  interaction  of  hydrogen  with  carbon, 
both  of  which  are  held  in  solution  by  the  iron 
existing  in  the  bowels  of  the  earth.  This  inter- 
action began  when,  in  the  process  of  cooling, 
the  earth  reached  the  state  of  a  red  star.  The 
difficultly  fusible  iron  and  carbon  liquefied  and 
solidified  first,  and,  owing  to  its  high  specific 
gravity,  the  iron  holding  in  solution  the  hydro- 
gen, settled  at  the  lower  strata  of  the  globe. 
Owing  to  the  high  temperature  prevailing  in  the 
depths  of  the  earth,  the  reaction  between  the 
iron  and  the  carbon  has  been  going  on  for  ages 
and  is  doubtless  going  on  now.  The  com- 
paratively low  specific  gravity  of  the  hydro- 
carbons causes  them  to  rise  as  naphtha  (petro- 
leum) to  the  surface,  passing  through  various 
strata,  which  modify  its  character"  (Bacon  & 
Hamer).  This  theory  seems  reasonable,  and 
it  gives  hope  for  the  future.  I  for  one  am 
glad  to  believe  it. 

If  we  creeping  humans  are  not  restricted  for 
our  sustenance  and  comfort  to  the  products  of 

128 


ON  THE  HISTORY  OF  OIL 

the  skin  of  the  earth  say,  a  mile  in  depth — 
but  if  we  draw  and  are  fated  to  continue  to 
draw  treasures  unspeakable  from  far  greater 
depths — as  Kizhner  indicates — perhaps  many 
miles  into  the  "bowels  of  the  earth,"  where  a 
creative  process  "has  been  going  on  for  ages 
and  is  doubtless  going  on  now" — then  it  argues 
great  luck  for  our  civilization,  or  the  amazing 
and  beneficent  designs  of  the  Almighty. 

The  changes  in  the  manner  of  living  that 
have  come  about  by  the  development  of  petro- 
leum as  an  article  of  commerce — as  already  said 
— are  both  radical  and  startling.  We  are  living 
in  a  petroleum  age  that  is  as  distinctive  as  was 
the  iron  age  or  the  age  of  coal.  And  the  oil 
influence  grew  slowly  for  a  long  time,  then 
in  two  decades  it  burst  upon  the  world  and 
changed  many  of  our  habits,  and  put  into  our 
hands  powers  of  the  most  phenomenal  sort, 
and  made  possible  a  war  involving  many  na- 
tions of  men,  and  of  unprecedented  destruction 
of  life  and  treasure. 

Iron  attained  its  influence  and  benefits  slowly. 
In  India  and  Britain  in  ancient  times  a  little 
iron  was  reduced  from  the  black  oxide.  Cast 
iron  was  known  four  or  five  hundred  years  ago. 
It  was  early  learned  that  antimony  melted  with 
iron  ore  would  reduce  the  melting  point  of  the 
iron.  This  made  it  more  practical  to  produce 
cannon ;  and  the  first  cannon  was  made  of  cast- 
iron  about  the  middle  of  the  16th  century. 
129 


ON  THE  HISTORY  OF  OIL 

Ordinary  iron  castings  appeared  a  century  and 
a  half  later,  i.  e.,  the  beginning  of  the  18th  cen- 
tury— to  be  exact,  in  1706.  The  Romans  in 
Britain  for  a  long  time  made  iron  by  smelting 
the  ore  with  charcoal.  But  eventually  the  for- 
ests seemed  in  danger  of  being  destroyed  to 
provide  charcoal.  In  1618  pit-coal  was  first 
used  for  smelting  iron  ore.  There  was  no  ques- 
tion that  for  the  sake  of  economy  this  ought  to 
have  become  the  prevalent,  if  not  the  sole,  prac- 
tice ;  but  the  ironmongers  were  accustomed  to 
the  charcoal-produced  article,  and  refused  to 
use  the  pit-coal  product.  So,  for  nearly  another 
century  (to  1710),  the  decimation  of  the 
forests  went  on  to  make  charcoal  for  smelting. 
Finally  this  had  to  cease.  The  pit-coal  product 
was  probably  inferior  any  way,  but  it  had  to 
come  into  use.  Iron  smelting  then  decreased 
for  some  fifteen  or  twenty  years,  when  it  was 
discovered  that  coke  can  be  produced  from 
coal.  This  made  iron  smelting  easy ;  and  the 
great  iron  age  then  (1740)  began  as  a  com- 
manding influence  in  the  commerce  of  the 
world. 

The  Watts  engine  came  in  1770.  Puddling 
and  rolling  of  iron  began  in  1784.  The  hot 
blast  came  in  1830,  Bessemer  steel  in  1855. 
Then  the  great  phenomenon  began — and  rail- 
roads, power  plants,  ships,  steel  buildings, 
engines  of  construction  and  destruction,  and  a 
thousand  lesser  industrial  uses,  have  changed 

130 


ON  THE  HISTORY  OF  OIL 

more  or  less  the  course  of  the  lives  and  living 
of  all  civilized  peoples.  They  have  changed 
the  economics  of  life. 

Coal  has  all  along  been  the  ally  of  iron  in 
the  advancement  of  mankind.  The  develop- 
ment of  the  steam  engine  gave  coal  its  greatest 
usefulness,  but  coal  was  a  long  time  coming  to 
its  maximum  work.  It  had  been  used  as  a  fuel 
since  long  before  the  Christian  era.  It  made 
possible  glass  manufacture  early  in  the  17th 
century  (1619),  but  not  till  steel  and  the  steam 
engine  were  developed  did  its  enormous  push 
come  about.  Bessemer  steel  came  in  the  mid- 
dle of  the  last  century,  and  a  quarter  of  a 
century  later  the  United  States  mined  in  a 
single  year  forty-seven  million  tons  of  coal. 

Thus  both  iron  and  coal  by  a  few  inventions 
for  their  better  elaboration  came  into  power 
with  a  rush.  So  it  was  with  petroleum,  and  the 
increase  in  the  use  of  it  for  the  last  half  century 
has  been  phenomenal — its  consumption  has 
now  reached  seventy-five  fold  of  the  figures  of 
1870.  The  greatest  jump  was  during  the  first 
decade  of  this  century,  when  the  production  in 
the  United  States  bounded  from  over  60  mil- 
lions of  barrels  (42  gallons)  anually  to  376 
millions  per  year.  Today  we  are  producing  at 
the  rate  of  nearly,  if  not  quite,  450  millions  of 
barrels1,  and  we  are  importing  from  Mexico  at 
the  rate  of  over  90  million  barrels  annually. 

1  R.  L.  Welch. 

131 


ON  THE  HISTORY  OF  OIL 

Yet  we  are  trying  to  consume  and  send  abroad 
more  than  we  are  able  to  produce,  and  more 
than  we  can  get.  And  all  over  the  world  oil 
men  are  drilling  the  crust  of  the  earth  as  never 
before,  in  trying  to  keep  pace  with  the  demand 
— and  unsuccessfully. 

There  are  today  twenty-one  countries  pro- 
ducing petroleum.  Seventeen  of  them  produce 
over  35,000  bbls.  each,  annually.  The  United 
States  produces  about  69  per  cent,  of  the 
world's  output,  and  we  are  supposed  to  control 
about  18  per  cent,  of  the  oil  still  underground. 
We  ought  to  control  much  more,  considering 
our  size  and  importance  as  a  nation.  But  some 
17  nations  have  laws  that  discriminatingly 
restrict  us  from  operating  within  their  borders 
— while  we  have  no  such  laws.  Foreigners 
have  acquired  vast  holdings  of  oil  properties 
in  this  country,  which  they  are  exploiting  to 
their  profit. 

We  have  increased  our  production  of  oil  five 
fold  in  the  last  twenty  years ;  but  the  demands 
have  run  even  faster.  Automobiles  began  to 
be  practical  twenty-five  years  ago ;  now  we  have 
in  this  country  7,500,000  of  these  machines— 
and  they  have  increased  nearly  or  quite  nineteen 
fold  in  ten  years,  while  tractors  have  increased 
fifty  fold  in  the  same  time,  and  now  we  have 
300,000  of  them.  The  United  States  Shipping 
Board  has  a  lot  of  oil-burning  ships — they 
need  40  million  barrels  of  petroleum  annually. 

132 


ON  THE  HISTORY  OF  OIL 

Some  of  the  great  ocean  liners  are  being  trans- 
formed from  coal  to  oil  burners,  and  oil  burn- 
ing ships  are  still  being  built.  From  prac- 
tically no  production  twenty  years  ago,  Mexico 
has  an  output  now  at  the  rate  of  nearly  or 
quite  100,000,000  bbls.  of  petroleum  per  year 
— and  we  get  the  major  part  of  it.  Still  there 
is  not  oil  enough  to  go  round. 

Nearly  all  the  lubricating  oil  of  the  world 
comes  from  petroleum.  It  could  not  be  pro- 
duced in  any  other  way,  and  when  this  source 
runs  down  the  amount  of  machinery  of  the 
world  will  shrink  correspondingly.  We  are 
making  the  astounding  figure  of  over  20,000,- 
000  bbls.  of  lubricants  per  year  in  the  United 
States.  That  would  fill  three  hundred  of  the 
largest  tank  ships — a  twenty-five  mile  string  of 
vessels. 

A  glance  at  the  system  of  oil  pipe-lines  in 
this  country  shows  the  enormous  size  of  the 
industry.  There  are  34,000  miles  of  trunk 
lines  and  over  11,000  miles  of  gathering  lines 
in  the  various  fields,  making  a  total  of  over 
45,000  miles  of  pipe.  The  cost  per  mile  of  8- 
inch  line  in  pre-war  time  was  about  $6,500. 
Pumping  stations  cost  from  $130,000  to  $250,- 
000  each. 

We  have  made  some  progress  toward  econ- 
omy in  the  production  and  use  of  oil,  and  still 
more  economy  is  needed.  A  vast  amount  of 
gas  comes  off  from  the  wells  with  the  oil. 

133 


ON  THE  HISTORY  OF  OIL 

This  gas  contains  a  good  deal  of  light  gasoline 
— called  "casing-head"  gasoline.  Now  by  va- 
rious methods  much  of  it  is  saved ;  formerly 
it  was  mostly  lost.  The  saving  amounts  to 
many  millions  of  barrels  annually. 

From  some  of  the  gusher  wells  of  the  largest 
production  and  highest  pressure,  the  amount  of 
gas  discharged  amounts  to  many  million  cubic 
feet  daily.  This  becomes  a  matter  of  large 
profit  if  the  gas  can  be  utilized,  and  of  peril 
to  people  and  animals  if  it  must  be  discharged 
into  the  air. 

As  a  matter  of  fact,  in  some  cases,  it  is  im- 
possible to  utilize  more  than  a  small  fraction 
of  the  gas,  and  the  surplusage  is  piped  away  to 
a  safe  distance  and  burned  from  tall  stand  pipes 
to  get  rid  of  it.  I  know  of  some  hills  in  far 
away  regions  of  Mexico  where  flames  of  this 
sort  have  for  years  continuously  lighted  the 
country  round  about — a  pathetic  notice  of  a 
so  far  unavoidable  wastage. 

The  loss  from  crude  oil  and  gasoline  by  evap- 
oration makes  in  the  aggregate  an  enormous 
item,  and  better  devices  are  needed  to  lessen  it. 
Our  U.  S.  Bureau  of  Mines  estimates  that  our 
present  loss  by  such  evaporation  costs  us  150 
million  dollars  per  annum. 

One  great  hope  for  economy  in  the  use  of 
petroleum  is  the  Diesel  Engine.  This  is  a  true 
internal  combustion  machine,  that  burns  light 
crude  oil  or  25  gravity  (Baume)  distillate,  and 

134 


ON  THE  HISTORY  OF  OIL 

works  well,  if  not  perfectly,  although  requiring 
more  skill  to  handle  than  the  steam  engine.  It 
is  adapted  to  all  freight  and  other  slow-going 
vessels,  and  to  stationary  machinery.  And, 
rightly  used,  it  multiplies  by  three  the  power 
production  of  the  oil  as  compared  with  burning 
it  under  steam  boilers. 

Something  more  must  be  done  to  prevent  the 
present  trend  of  exhaustion  of  our  oil  supply, 
without  catching  up  with  the  demand.  Lately 
there  has  been  noted  a  slowing  down  of  the  ex- 
cessive use  of  gasoline  in  automobiles.  A  great 
many  of  the  pleasure  cars  ought  to  eo  out  of 
commission.  We  need  to  recede  a  little  (or 
is  it  advance?)  toward  simpler  lives — and  fewer 
automobiles. 

Theoretically,  we  ought  to  try  to  hold  the 
present  rate  of  production  of  oil  about  where 
it  is,  and  not  attempt  to  increase  it,  but  let 
commerce  adjust  itself  to  the  situation  as  best 
it  may.  But,  practically,  such  a  thing  is  impos- 
sible. We  shall  doubtless  go  on  attempting  the 
impossible — trying  to  keep  production  ahead 
of  consumption.  But  the  draining  of  the  high 
producing  fields  will  soon  enough  drive  us  to 
those  of  moderate  and  low  production,  and  so 
force  down  the  demand  as  the  price  keeps  up. 

One  step  in  relieving  the  oil  demand  is  to 
rush  the  development  of  power  by  falling 
water,  in  every  place  where  this  is  possible. 
Another  possibility  in  economy  would  be  to 

135 


ON  THE  HISTORY  OF  OIL 

debar  the  murderous  pest  of  reckless  speeders 
from  driving  automobiles — to  the  killing  of 
thousands  of  people  every  year. 

We  are  now  surely  exhausting  the  under- 
ground reservoirs  at  a  frightful  rate.  But  the 
pessimists  are  wrong  in  their  guess  that  petro- 
leum will  run  out  entirely  within  the  space  of 
a  generation  or  two.  It  will  take  a  thousand 
years  to  do  that ;  and  petroleum  will  be  a  factor 
in  commerce  for  at  least  five  hundred  years 
more.  Long  before  such  final  exhaustion,  we 
shall  be  drilling  into  and  taking  the  oil  from 
the  deepest  of  the  known  oil  horizons ;  and 
there  may  be  several  more  such  horizons  below 
the  deepest  of  our  discoveries  so  far — nobody 
knows,  but  the  assumption  is  warranted. 

While  this  recession  is  going  on,  we  shall  be 
profitably  roasting  out  of  the  cliffs  of  shale  that 
we  know  of,  the  oil  that  is  there  but  does  not 
seem  to  be.  Then  we  will  find  other  mountains 
of  shale  ad  infinitum—and  if  not  infinitum  and 
if  the  oil  should  finally  run  out  entirely,  we 
shall  have  learned  how  to  utilize  the  sun's  rays 
for  power,  and  so  be  able  to  get  on  rather  nicely 
without  the  oil.  But  what  if  the  theory  of 
Kizhner  should  be  true,  that  petroleum 
is  being  made  now  in  the  bowels  of  the  earth, 
so  as  to  renew  to  some  degree  our  supply  of 
oil  for  say  two  million  years  more !  Let  us  be 
calm  as  well  as  sensible,  and  not  borrow 
trouble ! 

136 


Looking  Ahead 


Looking  Ahead* 

A  profession  is  different  from  a  trade.  The 
ideal  of  a  trade  is  to  create  hab'ts  in  the 
apprentices,  cerebral  and  muscular  automa- 
tisms, for  doing  a  thing  always  in  the  one  and 
the  same  way ;  to  create  habits  like  the  untaught 
instinct  of  the  birds,  who  have  an  uncanny 
knack  of  nest  building. 

In  a  profession  the  automatism  sought  is 
quite  as  essential,  but  it  contributes  most 
toward  the  ultimate  aims  of  the  guild.  That 
purpose  is  fixed  and  unalterable;  in  our  pro- 
fession it  is  nothing  less  than  the  bodily  wel- 
fare of  all  clients  and  all  people.  We  are 
to  prolong  the  lives  to  the  utmost,  and  reduce 
the  pains  of  every  sufferer  who  comes  to  us  or 
to  whom  we  are  sent.  More  than  that,  we  are 
to  establish  public  hygiene,  and  try  to  compel 
the  public  to  avoid  sickness,  and  so  escape  our 
personal  ministrations. 

The  means  to  the  end  vary  in  a  hundred 
ways,  and  we  acquire  expertness  in  judgment 
and  in  certain  manipulations,  but  the  goal,  the 
weal  of  the  people  we  serve  and  the  public,  is 
forever  the  same.  That  is  the  "brow  of  the 


'Commencement   address   at    Rush    Medical    College    of   the 
University   of   Chicago,   June    16,    1920. 

139 


LOOKING  AHEAD 

hill"  on  which  our  vision  is  fixed,  and  we  can- 
not change. 

The  carpenters  form  associations  for  per- 
sonal amusement  and  cultivation  of  the  mind, 
and  for  the  safety  of  their  incomes — if  not 
their  earnings. 

The  doctors  likewise  have  associations,  but 
if  these  fail  of  the  purpose  to  make  the  mem- 
bers more  efficient  to  lengthen  life  and  shorten 
pain,  they  are  in  peril  of  the  god  of  the  ulti- 
mate ethics. 

In  the  main  our  record  is  good.  We  have 
lessened  suffering  by  a  few  apparent  miracles — 
although  starting  some  drug  habits  that  have 
ruined  a  lot  of  people.  We  have  lengthened 
the  average  span  of  human  life,  which  is 
another  proof  of  our  usefulness. 

We  have  found  out  and  learned  to  destroy 
the  causes  of  several  diseases  that  formerly 
devastated  whole  nations ;  but  we  have  ahead 
of  us  a  hundred  problems  still  seeking  solution  ; 
and  new  ones  now  unthought  of  will  arise; 
and  the  story  will  never  be  finished. 

The  last  three-quarters  of  a  century  have 
given  us  a  whirlwind  progress  in  the  sciences 
connected  with  medicine.  And  for  the  exam- 
ination and  study  of  the  human  body  in  dis- 
ease we  have  a  bewildering  swarm  of  instru- 
ments, reactions,  methods  and  means — physical, 
chemical,  bacteriological  and  otherwise — all 
contributing  to  diagnosis  and  treatment. 

140 


LOOKING  AHEAD 

This  progress  has  made  necessary  numerous 
experts  in  using  and  applying  the  various 
means  and  measures ;  and  we  have  the  experts, 
and  they  are  skilled  indeed.  It  is  doubtful 
that  any  normal  man  is  capable  of  becoming 
highly  expert  in  the  use  of  all  these  various 
instruments  and  methods.  If  one  were  thus 
universally  expert  it  would  argue  him  as 
unnormal. 

The  practice  of  medicine  in  American  cities 
is  divided  into  some  twenty-five  specialties 
and  the  work  of  the  general  practitioner — 
otherwise  the  generalist.  The  generalists  are 
probably  five- fold  more  numerous  than  all  the 
specialists  combmed.  Most  of  them  are  doing 
their  work  better  than  it  was  ever  done  before. 
But  a  few  of  the  specialists  are  cramped  in 
vision  by  their  devotion  to  a  narrow  field. 
With  these  it  is  another  case  of  being  unable 
fully  to  appreciate  the  forest,  by  reason  of  the 
trees.  And  too  many  of  the  generalists  are 
hazy  about  both  the  trees  and  the  forest. 


And  now  we,  in  this  particular  alliance,  are 
conniving  at  more  intense  specialization,  for 
there  will  soon  come  the  destruction  of  the  old 
Rush  building,  and  the  creation  on  its  ruins  of 
a  greater  Rush — not  a  new  "Rush  Medical 
College,"  for  the  old  one  will  then  pass  into 
history,  but  a  new  "Rush  Postgraduate 

141 


LOOKING  AHEAD 

Medical  School  of  the  University  of  Chicago." 
This  change  will  mark  an  epoch  and  have  a 
double  purpose:  (1)  the  drilling  as  experts 
in  medicine  of  some  of  the  more  ambitious 
men  through  long  and  serious  study;  and  (2) 
general  research  in  all  our  sciences,  and,  please 
God,  the  solution  of  some  of  the  riddles  of 
human  disease  that  have  stared  us  in  the  face 
through  all  the  years. 

While  the  name  "Rush  Medical  College" 
will  disappear  as  a  teaching  body,  its  legal  or- 
ganization will  not  die,  but  will  remain  to  pre- 
serve its  charter  (the  oldest  educational  one 
alive  in  Illinois),  and  for  the  avails  of  some 
bequests  of  value  that  are  known  to  exist.  Nor 
does  its  going  mean  the  ending  of  the  work  it 
has  done  with  a  constant  upward  trend  for 
nearly  a  century.  That  work  will  be  taken  up 
without  a  break,  and  be  carried  forward  under 
the  ampler  torch  of  a  world  university.  And  the 
name  of  Rush,  so  precious  to  us,  will  still 
hallow  this  spot,  and  be  dignified  by  its  connec- 
tion with  the  next  step  forward  of  the  Uni- 
versity. And  every  alumnus  will  be  the  gainer. 

Our  specialists  and  generalists  confront 
us  with  many  problems.  We  are  so  much 
engrossed  in  the  highly  cultivated  special  fields 
that  we  too  rarely  visualize  the  well  man  or  the 
sick  man  as  a  whole.  It  drives  out  of  our 
minds — if  indeed  we  ever  had  it — the  picture 
that  should  be  vivid  and  constant  in  our  imagi- 

142 


LOOKING  AHEAD 

nation,  of  the  whole  body  as  though  trans- 
parent, with  all  its  organs  and  machinery  in 
action.  As  a  rule  nobody  does  that  well  but 
the  highly  cultivated  and  efficient  generalist. 
And  if  he  will  have  a  critical  spirit  and  listen 
to  the  voices  in  the  air  he  has  more  chance  to 
become  the  great  philosopher  physician  than 
any  other  man.  He  can  do  certain  forms  of 
research  of  value  which  few  others  can  or  will 
do.  He  is  enticed  to  study  and  consider  the 
patient  as  a  whole ;  and  he  can  measure,  and 
often  needs  to,  the  limitations  of  the  special- 
ists as  no  other  man  can;  and  he  can  jog  the 
minds  of  these  men  when  they  forget,  as  they 
at  times  seem  to,  that  no  organ  in  the  human 
body  lives  unto  itself  alone. 

In  the  growth  of  specialties  we  have  seemed 
in  danger  of  shelving  or  degrading  the  general- 
ist, whereas  if  he  is  alive  to  his  occasion  he  is 
the  most  important  man  among  us.  He  ought 
to  be  the  wise  judge  and  coordinator  of  the 
specialties ;  the  first  conserver  of  the  interest  of 
the  patient,  and  not  least  in  his  use  and  profit 
from  the  services  of  the  specialists. 

In  the  history  of  medicine  nothing  has  so 
magnified  the  importance  and  possible  useful- 
ness of  the  generalist  as  the  perfection  of  the 
specialties.  I  say  "possible  usefulness" 
because  we  hear  from  some  of  the  specialists 
that  some  of  the  generalists  are  so  poorly 
informed  that  they  don't  know  when  their 

143 


LOOKING  AHEAD 

patients  need  other  help  than  their  own.  A 
few  of  the  specialists  say  in  their  wrath  that  all 
the  generalists  are  in  this  class.  This  is,  of 
course,  not  true,  but  it  reveals  an  unfortunate 
situation,  and  a  real  one;  too  many  of  the 
generalists  are  at  fault;  and  it  is  due  to  two 
lamentable  facts;  one  is  the  magnified  impor- 
tance of  his  particular  work  in  the  mind  of  the 
casual  specialist.  This  is  not  surprising — he 
knows  and  daily  works  in  his  field,  and  in  that 
alone,  and  it  needs  a  broad  mind  not  to  over- 
emphasize its  importance.  Also  he  has  prob- 
ably discovered  that  some  generalist  has 
neglected  patients  who  were  in  sore  need  of  the 
services  of  his  particular  specialty. 

The  other  fact  is  that  many  generalists  are 
densely  ignorant  of  the  worth  of  the  special- 
ists. It  is  reprehensible  ignorance,  for  the 
generalist  ought  to  keep  himself  informed  of 
the  work  of  every  specialty.  He  should  see 
often  the  work  of  his  neighbors  in  special  lines ; 
and  particularly  he  should  see  a  lot  of  surgical 
operations — more  than  any  other  doctor  save 
the  surgeons  themselves.  And  he  should  see 
every  autopsy  possible,  for  it  is  a  helpful  rule 
that  the  generalist  should  see  the  human  body, 
both  the  dead  and  the  living,  under  section 
more  often  than  any  other  person.  No  gener- 
alist can  reach  the  heights  without  following 
this  rule. 

Now,  in  order  further  to  maintain  this  stand- 

144 


LOOKING  AHEAD 

ard  the  generalist  must  develop  and  maintain 
a  high  and  critical  quality  of  scholarship.  How 
can  he  do  this?  He  must  fight  against  two 
adverse  forces;  one  is  indolence  and  the  wast- 
ing of  time  over  trifles — otherwise,  puttering. 
He  must  keep  accurate  records  of  his  work  and 
learn  to  hate  slip-shod  statements  and  records. 
He  must  be  with  his  patients  a  cross-examin- 
ing lawyer,  in  order  to  sift  their  testimony  and 
get  at  the  exact  facts,  for  failure  as  to  the  facts 
spoils  a  quarter  of  the  diagnoses.  Some  experi- 
ence in  proof-reading  would  help;  it  tends  to 
create  a  critical  sense  that  is  indispensable. 
Then  he  must  search  the  literature  to  clear  up 
doubts — and  he  must  have  doubts.  And  if  he 
has  doubts  and  seeks  light,  he  will  have  the 
current  and  most  authoritative  literature.  He 
must  cut  out  the  waste  of  time  from  much 
reading  of  daily  newspapers.  He  will  buy  new 
books — not  with  leather  bindings ;  he  will  take 
and  read  the  one  greatest  journal  (of  the  A.  M. 
A.,  of  course)  and  have  some  journals  of 
research  (there  are  several  of  them  in  English). 
Thus  he  will  escape  the  intellectual  drought  of 
regarding  the  present  day  enigmas  of  science 
as  necessarily  among  the  unknowable.  He 
will  also  probably  escape  that  heretical  belief — 
the  mother  of  dry-rot — that  a  few  favorite 
prescriptions  cure  most  of  his  patients,  when 
he  knows,  if  he  thinks,  that  more  than  ninety- 
five  per  cent,  of  all  his  patients  recover  spon- 

145 


LOOKING  AHEAD 

taneously  if  they  are  allowed  to  rest,  and  that 
his  chief  service  to  the  sick  must  be  to  assuage 
the  suffering  and  dismay  of  all,  and  to  fight  off 
death  for  the  few ;  and  to  do  this  he  must  fight 
his  own  temptation  to  procrastination — a  pro- 
crastination that  would  put  off  antitoxin  to  the 
fourth  day  of  diphtheria  and  delay  appendec- 
tomy till  perforation  of  the  appendix. 

Never  before  in  the  history  of  the  world  was 
it  so  necessary  as  now  for  scholars  in  general 
to  try  to  coordinate  and  make  useful  to  the 
mass,  the  flood  of  special  knowledge  of  many 
orders,  which  experts  have  created  in  these 
later  years.  Only  a  few  can  know  in  detail 
the  growth  and  significance  of  each  of  the  many 
new  or  newly  developed  kinds  of  knowledge ; 
but  every  scholar  who  essays  to  the  widest  use- 
fulness may  know  what  each  class  of  knowledge 
can  be  made  to  do  in  the  general  scheme  of 
betterment ;  and  he  ought  to  and  he  must  col- 
laborate with  the  masters  of  each  specialty  for 
the  general  good. 

A  recent  reviewer1  gives  out  this  wail  anent 
the  confession  of  his  own  ignorance  by  that 
phenomenal  egotist,  Henry  Adams,  in  his  book 
on  his  own  education :  "Not  that  one  does  not 
sympathize  fully  with  the  admission  of  ignor- 
ance. The  best  and  the  wisest,  the  most 
earnest  and  the  most  thoughtful,  admit  it  like- 


1  Gamaliel   Bradford,  in   the   Atlantic   Monthly. 

146 


LOOKING  AHEAD 

wise.  The  vast  acceleration  in  knowledge  of 
which  Adams  complained  is  the  distinguishing 
feature  of  the  twentieth  century.  We  are 
swamped,  buried,  atrophied  in  the  accumula- 
tion of  our  own  learning.  The  specialist  is  the 
only  relic  of  old  wisdom  that  survives,  and  the 
specialist  is  but  a  pale  and  flickering  torch  to 
illuminate  the  general  desolation  of  ignorance." 

But  there  is  no  occasion  for  either  alarm  or 
despair.  We  only  need  more  wisdom  and  econ- 
omy in  our  own  education,  and  in  our  use  of 
the  enormous  mass  of  special  knowledge,  so  as 
to  make  it  into  working  tools  for  the  world's 
progress,  and  not  the  means  of  choking  our 
minds. 

Once  upon  a  time  some  pedagogues  told  us 
that,  as  each  new  kind  of  knowledge  came 
along,  it  must  be  added  to  the  existing  curricu- 
lum and  learned  by  all  students  who  desired  a 
correct  education.  The  old  requirement  of 
Latin  and  Greek  could  not  be  lessened  without 
grave  danger  of  intellectual  ruin.  But  it 
failed.  The  students  grew  broad  in  their  heads 
and  narrow  in  their  bodies,  and  beyond  a  cer- 
tain point  their  mental  cramming  was  a  meas- 
ure of  their  increasing  uselessness.  We  need 
to  make  the  general  scholar  so  broadly  learned, 
so  comprehensive  in  his  knowledge  of  the 
human  body,  that  he  cannot  master  the  details 
of  the  restricted  specialist,  and  he  must  not 
pretend  to.  But  he  must  know  as  none  other 

147 


LOOKING  AHEAD 

knows,  how  to  help  those  restricted  experts  to 
the  greatest  usefulness  for  the  general  good. 

Thousands  of  new  laws  are  enacted  every 
year  in  the  various  legislative  bodies  in  this 
country  by  people  who  think  they  know  what 
their  constituencies  need.  But  no  lawyer  can 
keep  track  of  a  tenth  of  these  laws,  except  by 
the  aid  of  his  Digest  of  the  Statutes. 

Each  live  generalist  must  make  his  own 
Digest  of  the  accomplishments  of  each  of  the 
specialties,  and  how  they  may  help  toward 
human  health.  And  this  Digest,  whether 
mental  or  written,  must  undergo  repeated 
changes  as  special  knowledge  grows  and 
changes.  It  must  be  like  a  loose-leaved  cyclo- 
pedia ;  a  new  leaf  must  often  go  into  the  book, 
and  an  old  leaf  with  a  lot  of  what  yesterday 
was  knowledge,  but  has  ceased  to  be,  must  go 
out  of  it  and  to  the  scrap  heap — and  be  forgot- 
ten, if  possible.  The  failure  to  make  such 
changes  in  the  Digest  marks  the  begining  of  a 
deplorable  disorder  that  doctors  have  always 
been  in  danger  of,  namely,  intellectual  fossili- 
zation. 

Besides  keeping  the  Digest  constantly  up  to 
date,  there  is  for  the  doctor  one  other  remedy 
against  fossilization  ;  that  is  to  pray  constantly 
for  the  discovery,  the  clearing  up  by  somebody, 
sometime,  somewhere,  of  the  many  unsolved 
problems  in  medicine.  Even  more  important 
than  to  pray  for  it  is  to  expect  it,  to  look  for 

148 


LOOKING  AHEAD 

it,  for  that  means  a  mental  mood  that  pushes 
us  forward  to  help  in  the  search,  and  maybe 
the  solution  of  some  of  the  riddles. 

There  is  for  you  graduates  of  today  no  finer 
prospect  for  a  good  career  than  in  general 
medicine.  Of  course  it  requires  peculiar 
ideals,  temperment,  and  mental  grasp — and 
that  sort  of  selfishness  that  knows  that  the  basis 
of  ethics  is  the  largest  totality  of  happiness  in 
the  whole  existence  of  the  individual.  If  you 
like  people — folks — and  like  to  see  them  avoid 
pitfalls;  if  you  can  look  on  their  foibles  with 
indulgent  humor ;  if  you  can  forgive  their  sins, 
as  you  know  your  own  fallibility,  and  be  glad 
to  help  them  up;  if  you  can  scotch  that  enemy 
of  character,  a  youthful  itching  for  big  fees, 
and  envy  of  those  who  get  them  before  you  do ; 
if  you  can  early  learn  how  simple  and  few  your 
real  wants  are,  and  that  the  satisfaction  of 
doing  each  day  the  best  that  is  in  you  is  better 
than  the  trappings  of  luxury;  and  if  you  will 
swear  that  neither  success  nor  riches  shall  lead 
you  to  vanity  or  ostentation,  or  to  forget  your 
days  of  small  things ;  then  you  can  become  a 
great  general  physician  and  citizen,  and  you 
will  have  a  shining  trail  of  satisfaction  ahead 
of  you. 

*     *     * 

Our  progress  in  the  education  of  doctors 
and  nurses  during  the  last  third  of  a  century 
we  know  to  be  commendable.  The  public  is 

149 


LOOKING  AHEAD 

better  treated  and  nursed  than  ever  before. 
But  great  reforms  are  often  attended  with 
some  misfortunes  and  abuses.  So  here  we 
have  fallen  into  some  harmful,  even  cruel  lines. 
We  have  separated  the  people  into  two  classes, 
the  rich  and  the  poor;  or  those  first  who  can 
afford  to  pay  $25.00  a  week  for  a  hospital 
room,  with  $35.00  a  week  or  more  for  nursing, 
and  corresponding  doctors'  fees  for  elaborate 
diagnosis  and  treatment;  and  second,  those 
who  cannot  afford  to  pay  such  charges. 

The  breach  is  wide  between  these  two  groups, 
and  great  harm  is  being  done  to  a  large  com- 
pany of  excellent  people,  of  self-respecting 
wage-earners  and  others  of  moderate  means, 
whose  wish  is  to  pay  all  their  just  bills.  They 
cannot  afford  the  high  charges,  and  they  do  not 
relish  being  deprived  of  hospital  treatment 
except  on  the  terms  that  they  shall  go  to  the 
public  hospitals  for  paupers.  It  is  true  that 
occasionally  one  may  find  an  endowed  bed  in  a 
first-class  hospital — but  not  over  one  in  forty 
of  those  needed. 

In  many  communities  this  situation  amounts 
to  a  scandal  that  the  medical  profession  ought 
to  deal  with.  Nor  should  the  profession  alone 
deal  with  it,  but  all  self-respecting  lay  people, 
especially  those  who  have  learned  the  privilege 
of  giving  money  for  the  public  good. 

The  problem  involves  three  practical  needs : 
First,  cheaper  hospital  service.  We  must  have 

150 


LOOKING  AHEAD 

more  hospitals  that  are  cheaply  and  safely  built, 
cheaply  and  comfortably  furnished,  and  suf- 
ficiently endowed  so  that  a  small  room  can  in 
ordinary  times  be  furnished  for  $1.00  a  day. 
There  are  several  ways  in  which  this  can  be 
brought  about.  A  philanthropic  organization 
could  collect  funds  for  such  hospitals,  and  they 
could  be  built,  if  they  were  not  strictly  fire- 
proof, for  one-half  what  permanent  hospital 
accommodations  usually  cost.  And  it  is  not 
indispensable  that  in  a  one  or  two-story  hos- 
pital the  structure  should  be  strictly  fireproof. 
Remember  that  nearly  all  the  patients  who 
would  inhabit  such  a  building  come  from  homes 
which  are  highly  combustible,  and  the  hospitals 
would  be  fitted  with  fire-fighting  facilities, 
and  especially  with  means  for  rapid  removal 
of  patients. 

Some  existing  standard  hospitals  are  so  sit- 
uated that  they  could  build  a  cheap  pavilion  on 
grounds  adjacient  to  an  existing  structure,  and 
detached  from  it,  where  the  administration  of 
the  new  part  could  be  carried  on  with  economy. 
Any  existing  hospital  or  any  league  or  society 
that  would  start  out  with  the  unselfish  purpose 
of  creating  such  a  hospital  surely  would  find 
the  public  ready  to  help.  A  good  name  for 
such  a  novel  institution  would  be  "The  Inter- 
mediate Hospital."  A  better  name  would  be 
"The  Mediate  Hospital." 

The  next  condition  requisite  is  less  expensive 

151 


LOOKING  AHEAD 

nursing.  These  patients  cannot  afford  over 
$2.00  a  day  in  ordinary  times.  Registered 
nurses  cannot  work  for  that.  This  fact,  and 
the  need  for  less  expensive  nurses,  reveals  to 
us  one  of  the  hardships  that  have  grown  out  of 
our  commendable  profession  of  nursing.  We 
have  insisted  on  such  severe  conditions  for 
admission  to  our  better  training  schools,  and 
on  so  long  a  course  of  instruction,  that  we  have 
created  a  nursing  system  that  is  too  costly.  It 
is  necessary  to  have  nurses  who  can  work  for 
half  the  wages  that  a  registered  nurse  gets. 
The  best  remedy  is  a  new  one,  which  is  to  have 
young  women  with  some  grammar  school 
education  who  can  be  drilled  intensively  for  a 
few  months  on  the  simple,  cardinal  things  that 
all  nurses  must  do.  Any  bright  girl  can  be 
taught  in  sixty  days  to  take  temperatures,  pulse 
and  respiration  accurately,  to  prepare  and 
administer  invalid  diet,  to  administer  drugs  in 
numerous  ways,  to  give  baths  and  fomenta- 
tions, and  attend  to  the  personal  wants  of  the 
invalid,  and  to  keep  accurate  records  of  the 
patient,  and  of  her  own  doings.  For  the  aver- 
age invalid  these  are  the  chief  things  required 
of  a  nurse.  Of  course,  in  critical  cases  a  fully 
trained  nurse  would  be  necessary ;  also  in  most 
surgical  cases,  but  not  all ;  and  where  two  or 
three  nurses  were  required,  one  trained  nurse 
and  two  assistants  under  her  direction  would 
usually  be  all  sufficient. 

152 


LOOKING  AHEAD 

What  these  young  nurses  should  be  called  is 
a  matter  of  taste.  Cadets  or  nurses'  assistants 
would  do. 

This  plan  does  not  disparage  the  dignity  or 
calling  of  the  registered  nurse.  Her  standing 
would  rather  be  enhanced  if  she  had  among  her 
other  attainments  the  ability  to  manage  and 
teach  cadet  nurses  under  her. 

There  is  now  a  demand  in  many  quarters  for 
more  nurses.  This  plan  would  provide  more 
nurses ;  and  the  good  offices  of  the  present  reg- 
istered nurses,  and  a  little  more  patience  on  the 
part  of  the  doctors,  would  make  it  certain  that 
nursing  as  a  whole  would  not  be  lowered  in 
standard,  but  rather  improved,  when  we  con- 
sider that  many  patients  would  have  nurses 
with  some  training  who  now  are  nursed  solely 
by  inefficient  lay  friends. 


As  to  the  training  schools  for  nurses,  it  is 
a  serious  question  whether  their  curriculum 
should  not  be  changed.  For  example,  the  stu- 
dents are  taught  from  books  the  anatomy  and 
physiology  of  the  human  body.  Most  of  that 
could  be  left  out  without  harm.  With  that 
omitted  and  more  time  given  to  laboratory 
work,  in  examinations  of  the  secretions,  excre- 
tions and  tissues  of  the  body,  chemically  and 
microscopically;  and  if  the  nurses  were  taught 
more  of  the  social  and  public  health  usefulness 

153 


LOOKING  AHEAD 

in  store  for  them,  we  would  probably  improve 
the  output. 

And  it  is  a  serious  question,  now  being  agi- 
tated, whether  the  three-year  course  for  a 
woman  who  has  already  had  some  academic 
training  is  not  six  months  or  a  year  longer 
than  is  necessary.  Dr.  Philip  King  Brown,  of 
San  Francisco,  a  broad  minded  physician  and  a 
wise  observer  of  this  subject,  says:  "There  is 
nothing  in  the  training  of  nurses  for  the  work 
that  most  of  them  do  that  warrants  three  years 
spent  in  getting  that  training." 

Suggestions  of  this  sort  will  probably  be 
unwelcome  to  training  school  managers,  but 
we  need  to  face  conditions  as  they  are;  and, 
with  the  evolving  conditions  in  society  and  in 
science,  it  behooves  us  not  to  fancy  that  we 
have  reached  perfection  in  our  methods.  We 
should  have  minds  open  for  any  improvement 
that  demonstrates  its  title.  And  one  of  the 
"things  as  they  are"  is  the  fact  of  a  vast  mul- 
titude of  people  between  the  two  extremes  of 
the  rich  and  the  very  poor,  who  need  and  de- 
serve some  better  things. 

Third,  we  must  have  lower  fees  for  diagnosis 
and  treatment  for  the  people  of  small  means. 
Most  doctors  have  in  the  past  been  ready  to 
temper  their  fees  to  the  purses  of  their  pa- 
tients. They  will  continue  to  do  this,  and  it 
would  be  easy  to  arrange  this  matter  for  the 
patients  in  the  mediate  hospitals,  if  they  shall 
materialize. 

154 


LOOKING  AHEAD 

But  the  cost  of  expert  examinations  for  diag- 
nosis, while  perfectly  fair  for  the  work  done 
and  for  the  skill,  is  often  too  much  for  the 
average  wage  earner  in  ordinary  times.  In  all 
such  cases,  I  am  sure,  the  fees  will  be  moder- 
ated to  meet  the  situation. 
*  *  * 

You  can  easily  divide  your  own  profession 
into  two  classes.  If  you  will  observe  sharply 
your  doctor  neighbors,  how  they  converse  with 
you  on  professional  matters,  and  how  they  be- 
have on  the  witness  stand  as  experts,  you  will 
easily  range  them  into  two  classes;  those  first 
who  are  able  to  tell  their  own  blunders  to  their 
friends,  and  are  able  easily  to  say  to  their 
friends  and  as  experts  in  court  that  they  "don't 
know" ;  and,  second,  those  who  are  unable 
to  do  either  of  these  simple  things.  My  advice 
to  all  young  doctors  is  to  try  to  belong  to  the 
former  class,  for  they  are  big  men ;  the  latter  is 
a  group  of  smaller  men. 

I  once  heard  a  great  and  courageous  surgeon 
tell  how  he  as  well  as  his  patient  on  a  certain 
occasion  escaped  some  surgery.  It  was  rather 
early  in  his  surgical  career.  In  the  presence 
of  some  doctors  he  had  opened  an  abdomen, 
hoping  to  account  for  some  strange  symptoms 
that  had  defied  treatment.  Only  one  abnormal 
thing  was  found.  A  piece  of  the  descending 
colon,  some  four  inches  in  length,  was  con- 
tracted to  a  narrow,  hard  cord.  He  showed 

155 


LOOKING  AHEAD 

this  to  his  audience  and  said:  "This  is  a 
chronically  inflamed  and  contracted  piece  of 
intestine.  Of  the  cause  we  are  ignorant,  but 
we  will  cut  it  out  and  unite  the  two  ends,  and 
the  man  will  recover."  While  he  was  prepar- 
ing to  make  the  section  he  and  his  friends  were 
startled  to  see  the  cord  slowly  dilate  and  be- 
come normal  like  the  rest  of  the  gut.  The  case 
was  one  of  tetanic  spasm  of  a  section  of  the 
colon — a  common  enough  event,  and  one  that 
is  rarely  even  referred  to  in  writings  on  abdom- 
inal disorders. 

Many  years  ago  a  much  prized  friend  of 
mine — since  become  famous  as  an  internist  and 
teacher — told  this  story  of  a  profitable  expe- 
rience of  his,  soon  after  his  graduation  from 
an  interneship.  The  hospital  had  given  him  a 
large  experience  in  many  things,  but  not  in  the 
erratic  psycho-neuroses.  He  was  called  in 
great  haste  to  a  young  lady  who  had  suddenly 
become  unconscious.  Two  doctors  had  been 
sent  for;  the  other  one  was  old  and  looked 
wise  as  well  as  venerable.  The  young  doctor 
arrived  first,  and  found  the  patient  lying  on 
her  back,  still,  stiff,  unconscious,  and  resting 
her  weight  largely  on  her  heels  and  head.  Her 
eyes  were  closed,  she  was  not  perceptibly 
breathing,  and  her  pulse  was  a  weak  and  flick- 
ering thing.  While  he  was  making  a  hasty 
examination,  her  friends,  with  tears  and 
screams,  begged  him  to  do  something  for  her. 

156 


LOOKING  AHEAD 

He  said  with  frank  candor :  "Why,  she  is  dy- 
ing— she  is  substantially  dead ;  her  breath  has 
stopped  and  her  pulse  is  nearly  gone."  They 
then  again  besought  him  to  do  something,  and 
he  replied :  "I  should  be  glad  to,  but  I  don't 
know  what  to  do  to  raise  the  dead." 

Just  then  the  old  doctor  appeared,  and  my 
friend  confided  to  him  that  death  was  immi- 
nent. The  old  man  at  first  seemed  nonplussed ; 
then  he  asked  the  young  man  if  he  had  tried 
polarity.  He  had  not;  he  had  never  heard 
of  it ;  and  the  old  man  proceeded  to  try  it.  He 
placed  one  hand  on  the  girl's  head  and  the 
other  on  her  pubic  bone  and  in  a  few  minutes 
she  took  a  deep  inspiration,  opened  her  eyes 
and  was  normal! 

For  illustration  of  the  calamities  likely  to 
befall  the  expert  witness,  you  should  know  the 
story  of  a  lawyer  of  a  former  generation  in 
Chicago  who  was  dangerous  as  a  cross-exam- 
iner. Once  in  court  he  led  a  medical  witness 
(who  was  scrupulous  about  his  reputation  for 
universal  medical  knowledge)  to  confess  that 
he  was  familiar  with  several  medical  books 
which  the  lawyer  named  as  he  held  heavy 
volumes  in  his  hands.  Yes,  the  doctor  had 
read  them.  The  lawyer  read  extracts  and 
asked  the  doctor  if  he  was  familiar  with  them. 
He  was.  Did  he  agree  or  disagree  with  the 
authors?  The  doctor  answered  promptly. 
After  the  witness  had  committed  himself  as  to 

157 


LOOKING  AHEAD 

several  books  and  many  questions  of  science, 
the  lawyer  turned  to  the  court  and  jury  and 
stated  that  there  were  no  such  authors  and 
no  such  books ;  that  the  books  he  had  pre- 
tended to  read  from  were  law  books ;  that  the 
titles  he  had  given  them  were  of  his  own 
invention,  and  the  pretended  extracts  were 
his  own,  and  that  he  had  resorted  to  this  device 
to  discredit  a  bumptious  and  ignorant  witness 
out  of  his  own  mouth.  Of  course  the  doctor 
was  humiliated,  by  what  he  richly  deserved ; 
but  that  same  trick  has  been  since  repeated 
in  the  Chicago  courts  at  least  three  times,  and 
once  with  an  extremely  reputable  physician. 
*  *  * 

Time  was  when  nearly  every  man  who  was 
graduated  in  medicine  had  before  him  a  long 
and  arduous  trial  in  learning  how  to  apply  his 
knowledge  to  the  needs  of  the  sick,  and  how  to 
deal  adaptably  with  the  well.  Usually  it  was 
a  painful  experience  for  the  young  doctor,  and 
sometimes  even  more  painful  for  his  patrons — 
in  nerves,  in  spirit,  in  hopes  and  plans;  in  a 
human  way  it  was  a  costly  experience. 

Later  came  the  time  when  a  few  men  had  the 
fortune  of  a  year  or  more  of  interneship  in  a 
general  hospital.  These  lucky  ones  gained  sev- 
eral years  over  their  fellows  in  the  professional 
race.  Now,  by  the  required  clinical  year,  all 
men  here  start  alike.  Nobody  expects  they  will 
remain  alike  and  together,  for  that  would  deny 

158 


LOOKING  AHEAD 

the  variation  among  human  beings.  But  it  is 
a  fair  way  for  all,  and  it  means  a  vast  economy 
to  the  public  as  well  as  to  the  doctors. 

Moreover,  it  will  help  to  remove  from  the 
minds  of  some  good  people  the  suspicion  that 
the  young  doctor  is  likely  to  be  dangerous. 
That  he  is  liable  to  be  dangerous,  we  among 
ourselves  freely  admit,  but  that  he  is  likely  to 
be,  we  deny.  We  scorn  that  adverb.  The 
thoughtful  graduate  from  a  hospital  will  be 
accepted  by  the  patients  in  the  mediate  hospitals 
of  the  future  with  the  certainty  of  good  treat- 
ment, and  the  young  doctor  so  serving,  who 
needs  most  of  all  and  as  early  as  possible  a 
large  clientele  and  wide  experience,  can  afford 
to  serve  these  patients  with  small  fees,  or  no 
fees  at  all. 

But  adding  a  year  to  the  education  of  the 
doctor  makes  him  entitled  to  an  average  of 
slightly  higher  fees,  and  the  public  can  for 
better  service  afford  to  pay  more,  but  the  load 
must  always  be  tempered  to  the  weak  shoulders. 
We  do  not  serve  the  public  for  money  alone; 
and  it  is  one  of  the  most  important  of  the  insti- 
tutes of  the  profession  that  we  shall  give  our- 
selves to  at  least  two  kinds  of  consecration. 
One  is  to  the  health  interest  of  the  public,  and 
in  this  we  have  made  good,  for  we  have  unself- 
ishly, persistently  and  gloriously  brought  down 
the  human  death  rate  and  prolonged  life;  and 
we  have  done  this  against  the  opposition  of 

159 


LOOKING  AHEAD 

some  blinded  devotees  of  strange  cults  who  be- 
lieve the  microbes,  the  insects  and  the  lower 
animals  have  greater  rights  in  the  universe 
than  human  babies.  The  other  consecration 
calls  for  a  like  unselfishness,  for  it  is  a  balanc- 
ing of  the  scales  of  justice  with  all  classes — 
the  rich  and  poor  alike — by  each  of  us  in  his 
own  little  world  of  people.  And  the  greatest 
pull  upon  our  conscience  must  be  for  the  major 
multitude  of  the  people  of  disadvantage.  Two 
blazing  truths  stand  forth :  One  is  that  most 
of  these  are  worthy  people,  among  whom  true 
saints  are  to  be  found ;  the  other  is  that  one  of 
the  greatest  of  all  the  virtues  is  mercy. 


160 


Hospitals  and  Nurses 


Hospitals  and  Nurses* 

In  our  recent  great  progress  in  the  care  of 
the  sick,  and  especially  in  their  hospital  care, 
all  of  which  has  done  a  great  amount  of  good, 
we  have  fallen  into  some  unfortunate  fashions. 
One  is  the  fashion  of  sending  all  of  the  sick 
that  we  can  to  the  hospital.  As  this  fashion 
has  increased,  the  home  habit  and  capacity  for 
health  conservation  have  decreased — or  failed 
to  advance  correspondingly. 

Today  the  hospitals  are  overcrowded,  and 
economists  as  well  as  doctors  are  wondering 
what  we  could  do  with  the  sick  if  a  withering 
epidemic  should  come  upon  us.  Notwithstand- 
ing the  great  patronage  and  high  charges,  the 
hospital  managements  protest  that  they  are  not 
making  money,  and  that  therefore  there  is  small 
inducement  to  build  new  hospitals  as  a  commer- 
cial venture. 

But  there  is  great  need  for  more  hospitals, 
especially  for  those  so  built  and  so  endowed 
that  the  room  charges  to  patients  would  be 
much  reduced  from  the  present  figures,  say  to 
One  Dollar  per  day.  Hospitals  should  be  built 

•Read  before  a  Branch  of  the  American  College  of  Sur- 
geons, Lo»  Angeles,  Calif.,  February  17,  1922. 

163 


HOSPITALS  AND  NURSES 

more  cheaply.  Inexpensive,  detached  buildings 
should  be  the  ideal.  I  know  fire-proof  struc- 
tures are  desirable,  but  they  are  very  costly. 
And  substantially  all  of  us  live  through  our 
whole  lives  in  combustible  houses.  Why,  then, 
couldn't  we  consent  to  go  to  a  Cottage  Hospital 
that  is  half  as  combustible  as  our  dwellings? 

The  hospital  fashion  should  be  modified. 
More  patients  should  be  cared  for  in  their  own 
homes,  and  many  more  minor  surgical  opera- 
tions should  be  done  there,  die  of  the  leading 
surgeons  has  just  told  us  how  he,  in  order  to 
avoid  the  mental  shock  of  operating  room 
gestures,  operates  on  certain  cases  in  their  beds 
in  the  hospital.  It  would  mean  more  labor  on 
the  part  of  the  household,  more  inconvenience 
for  the  doctors  and  nurses.  And  the  house- 
hold would  need  to  be  educated  in  the  unusual 
care  required — but  that  could  be  done — and  it 
would  be  for  the  large  benefit  to  the  community. 

There  should  be  to  some  degree  a  revival  of 
the  old  fashion  of  keeping  the  sick  at  home, 
and  there  should  be  in  the  household  more  real 
knowledge  and  less  guesswork  about  sickness 
and  nursing.  One  of  the  sorriest  burdens  of 
our  lives — a  great  handicap  to  most  of  our 
households — is  the  enormous  expense  of  sick- 
ness and  premature  death.  And  most  of  our 
homes  are  shockingly  uninformed  of  how  to 
conserve  health  and  fight  off  sickness.  And 
such  information  is  so  easily  acquired. 

164 


HOSPITALS  AND  NURSES 

Too  often  the  city  home  rests  on  the 
knowledge  that  the  hospital  is  nearby,  and  it 
has  forgotten  a  lot  of  simple  methods  of  car- 
ing for  the  sick,  and  so  a  sort  of  helplessness 
has  grown  up.  There  are  human  hands  enough 
in  half  the  homes  to  take  care  of  their  sick,  if 
only  they  were  not  so  ignorant,  so  easily  demor- 
alized, frightened  and  helpless. 

One  of  the  best  kinds  of  missionary  work 
today  in  many  of  our  communities  is  to  give  to 
the  lay  public,  the  women  especially,  instruc- 
tion on  first  aid  to  the  sick  and  injured;  and 
how  to  do  the  simple  things  of  nursing  the 
sick.  They  should  all  be  taught  how  to  take 
temperatures  accurately,  how  to  count  the  pulse 
and  the  respiration,  how  to  examine  the  phar- 
ynx, and  especially  how  to  record  their  findings 
— and  to  record  them.  They  should  be  in- 
structed how  to  make  accurate  records  of 
everything  pertaining  to  the  patient — his  food, 
sleep,  sensations,  suffering  and  otherwise;  his 
excretions,  and  all  changes  from  a  normal  con- 
dition. Whenever  did  it  happen  that  a  physi- 
cian, called  to  a  patient  sick  in  his  home  for 
three  or  four  days,  has  found  a  scrap  of  written 
history  of  the  case?  Not  once  in  five  hundred 
cases.  And  every  practitioner  knows  the  vital 
importance  of  the  history  of  the  beginning  of 
the  sickness,  for  diagnosis  and  prognosis. 

The  missionary  would  find  the  women  of  our 
households  greedy  for  such  instruction;  and 

165 


HOSPITALS  AND  NURSES 

every  housewife  and  daughter  would  become, 
by  a  few  lessons,  an  extremely  useful  observer 
and  nurse  for  simple  conditions.  By  more 
knowledge  they  would  be  more  sure  of  them- 
selves, less  in  danger  of  stampeding  by  sudden 
sickness  or  injury — and  so  their  courage  and 
self-respect  would  grow — to  their  comfort  and 
satisfaction — and  to  the  unspeakable  benefit  of 
their  sick  ones.  From  being  proud  of  their 
own  ignorance,  as  many  of  them  are  today,  a 
multitude  of  these  people  would  be  proud  to 
know  that  they  could  do  these  simple  and  use- 
ful things,  and  that  they  could  make  written 
records  that  any  physician  or  trained  nurse 
would  commend. 

The  missionary  would  help  to  remove  from 
the  public  mind  many  false  ideas  about  the  sick 
and  their  treatment — and  the  oft-found  notion 
that  education  in  medicine  is  needless,  and  that 
an  uncultivated  layman  may  know  the  myste- 
ries of  human  disease  by  intuition.  This  fool- 
ishness is  both  pathetic  and  grotesque. 

A  great  surgeon,  an  early  Fellow  of  the 
College^of  Surgeons,  had  once  prescribed  for 
his  mother-in-law.  The  next  day  she  came 
to  him  and  said,  "John,  I  have  just  seen  Mrs. 
Blank,  and  she  says  you  are  wrong  in  that  pre- 
scription of  yours."  He  replied :  "She  may 
be  right,  but  I  think  that  before  you  act  on 
her  suggestion,  you  ought  to  go  out  and  ask  the 
policeman  on  our  street  what  he  thinks  about 
it." 

166 


HOSPITALS  AND  NURSES 

One  of  the  most  crying  needs,  both  in  the 
hospital  and  in  the  home  is  for  less  expensive 
nursing.  People  of  moderate  means  cannot 
pay  $25.00  a  week  for  a  room  in  the  hospital 
and  thirty-five  to  forty  dollars  a  week  for  a 
trained  nurse.  There  are  millions  of  these 
people — the  best  in  all  the  world — and  they 
must  be  cared  for  in  their  homes,  if  they  have 
homes,  or  go  to  the  County  Hospital;  and 
those  who  have  no  homes  must  go  to  the  Coun- 
ty Hospital  anyway — which  is  a  pitiable  hard- 
ship. 

There  must  be — and  there  is  surely  going  to 
be — a  new  order  in  nursing  and  nurses.  We 
have  about  reached  the  point  where  nearly 
every  educated  nurse  has  been  educated  too 
expensively — so  expensively  that  her  charges 
are  too  high  for  people  of  moderate  means. 
The  remedy  is  to  educate  a  lot  of  nurses  less 
expensively,  who  can  work  for  half  the  fees 
of  the  highly  trained  ones.  They  should  be 
girls  and  young  women,  with  a  requirement 
of  not  more  than  a  grammar  school  education, 
who  will  be  trained  intensively  for  not  more 
than  two  or  three  months  to  fit  them  to  be  the 
assistant  nurses  or  cadets  under  the  supervision, 
in  critical  cases,  of  highly  trained  nurses,  and 
in  simple  cases  under  the  sole  direction  of  the 
physician. 

For  the  simple  things  of  nursing  of  the  av- 
erage case,  there  is  no  need  for  a  college  grad- 
167 


HOSPITALS  AND  NURSES 

uate,  or  even  a  high  school  graduate,  who  has 
been  instructed  two  or  three  years  in  facts  of 
physiology  and  anatomy  as  well  as  the  more 
practical  phases  of  nursing.  To  paraphrase 
an  utterance  made  elsewhere :  Any  bright  girl 
can  be  intensively  taught  in  sixty  days  to  take 
temperature,  pulse  and  respiration  accurately, 
to  prepare  and  administer  invalid  diet,  to  ad- 
minister drugs  in  all  ways  (except  intrave- 
nously), to  give  baths  and  fomentations,  and 
attend  to  the  personal  wants  of  the  invalid,  and 
to  keep  accurate  records  of  the  patient,  and  of 
her  own  doings.  For  the  average  invalid  these 
are  the  chief  things  required  of  a  nurse.  Of 
course,  in  critical  cases  a  fully  trained  nurse 
would  be  desirable ;  also  in  many  surgical  cases 
(probably  not  half  of  them)  ;  and  where  two 
or  three  nurses  are  required,  one  trained  nurse 
and  two  assistants  under  her  direction  will  be 
all  sufficient. 

At  present  our  highly  trained  nurses,  after 
probably  a  High  School  education,  possibly 
some  college  study,  and  three  years  of  training 
in  and  out  of  hospital,  are  doing  much — even 
mostly — routine  work  that  the  cadet  nurse 
could  do  well  enough.  The  highly  trained 
nurse  should  be  reserved  for  people  abundantly 
able  to  pay  her  (for  any  sort  of  a  case),  and 
for  critical  cases  and  critical  situations  requir- 
ing such  skill  as  she  alone  has.  The  advent 
of  cadet  nurses  would  dignify  and  make  more 
168 


HOSPITALS  AND  NURSES 

useful  the  highly  trained  nurse.  And  the  latter 
ought  to  favor  and  further  this  movement — for 
it  means  a  distinct  promotion  for  her.  By 
creating  a  lower  order  of  nurses,  the  dignity 
of  her  order  is  emphasized  and  advanced.  But 
lamentably  the  regular  training  schools,  as  well 
as  most  of  their  graduates,  are  opposed  to  the 
progressive  movement  here  advocated. 

The  high  class  training  schools  for  nurses 
might  profitably  revise  their  course  of  study, 
and  it  should  be  shortened  to  two  years  or  less. 
Most  of  the  anatomy  and  physiology  should  be 
cut  out  of  it,  and  there  greatly  needs  to  be 
added  some  instruction  in  the  psychology  of  the 
sick  as  compared  to  that  of  the  well.  The 
pupils  had  better  read  William  James  rather 
than  pore  over  the  medical  books  that  doctors 
have  to  struggle  to  master — if  indeed  they  ever 
do  master  them.  The  psychology  of  the  sick 
and  the  well  means  an  understanding  of  how 
to  manage  the  patient's  mind,  his  whims,  idio- 
syncrasies, his  prejudices,  and  maybe  his  delu- 
sions. And  a  nurse  who  has  learned  that  has 
unavoidably  learned  how  to  manage  her  own 
psychology,  often  to  hold  her  anger  and  her 
tongue ;  to  forget  some  of  her  crotchets,  and 
to  soothe  without  annoying.  And  a  nurse  who 
can  do  all  this  is  equipped  indeed — she  is  a 
rare  exception  to  the  rule. 

The  high  class  training  schools  now  are  cry- 
ing for  more  pupils  for  training.  It  is  no 

169 


HOSPITALS  AND  NURSES 

wonder  that  these  are  scarce.  Of  course  high- 
ly educated  young  women  balk  at  the  idea  of 
spending  three  or  more  years  in  learning  so 
simple  an  art  as  nursing  the  sick. 

Why  have  these  splendid  training  schools 
so  expanded  their  curriculum?  I  don't  know, 
unless  it  is  the  ambition  of  their  scholarly  su- 
perintendents to  create  a  nursing  profession  of 
scholars.  They  have  accomplished  that  pur- 
pose to  some  degree — but  to  the  loss  of  some 
greater  service  to  the  public  which  they  might 
render.  We  have  too  long  tried  to  attain  the 
impossible,  and  I  for  one  move  that  the  scholar 
nurses — magnificent  women  that  they  are — be 
reserved  for  situations  that  need  them  (and 
can  .adequately  pay  them),  and  that  cadet 
nurses  shall  do  for  the  multitude  the  tasks  that 
require  not  scholarship,  but  honesty,  faithful- 
ness, the  knowledge  really  required  for  their 
work,  and  that  divine  fragrance  called  common 
sense. 


170 


Cadet  Nurses  and  Home  Nursing 


Cadet  Nurses  and  Home  Nursing 

Suggestions  for  Organization 
of  the  Work 

A  good  field  for  the  development  of  home 
nursing,  of  cadet  nurses  for  the  weal  of  the 
needy  general  public ;  and  for  general  education 
in  such  matters,  including  ideal  practical  house- 
keeping, is  offered  to  average  communities  of 
say  10,000  people,  anywhere  in  this  country. 
The  requisites  might  be  listed  tentatively  as 
follows : 

1.  The  union  of  four  or  five  stable  medical 
men,  committed  to  this  idea,  and  able  to  work 
together  harmoniously  and  unselfishly  for  suc- 
cess.    Then  the  enlistment  of  a  few  lay  men 
and  women  of  progressive  ideas  and  vision  for 
public  benefit,  to  help  in  practical  ways. 

2.  Procure  some  old,  roomy  house  with  a 
large   lot.     Scrub  and   fumigate;   fix   and   fit 
the  house  for  an  aseptic  hospital  for  say  6  or  8 
patients,  one  room  for  operating;  or  a  small 
detached  building  could  be  made  with  operating 
room,  and  rooms  for  2  or  3  surgical  patients 
under  the  same  roof.     Detached  cottages  for 

173 


CADET  NURSES 

other  patients  could  be  built  on  the  same  lot 
as  needed.  Each  cottage  for  4  or  5  patients. 
The  expense  of  these  additions  would  not  be 
great;  wood  structure  probably.  Wide  spaces 
between  the  buildings. 

3.  Secure  one  or  two  highly  educated  and 
refined  trained  nurses,  with  capacity  for  teach- 
ing, to  take  charge  of  the  hospital  and  to  teach 
the  pupil  nurses,   both  by  lectures  and  drill. 
These  must  be  women  who  are  consecrated  to 
this  new  kind  of  missionary  effort. 

4.  The  pupils  would  be  from  the  homes  of 
the  town — women  from  16  to  40,  who  would 
live  at  their  homes,  and  give  a  few  hours  a  day 
to  the  lectures  and  the  practical  work  in  the 
hospital  under  the  head  trained  nurses. 

5.  The  course  of  study  and  training  in  home 
nursing  would  be  similar  to  that  designed  by 
Dr.  Robertson  of  the  Health  Department  of 
Chicago,  and  would  be  something  as  follows: 

(a)  A  course  of  lectures  and  demonstrations 
of  6  or  8  weeks,  an  average  of  two  hours  daily. 
The  class  might,  if  too  large,  be  divided  into 
two  sections,  each  section  coming  on  alternate 
days.     Each  lecture  and  demonstration  would 
consume  at  least  two  hours,  one  hour  for  each. 
And  the  pupils  would,  as   far  as  practicable, 
enter  into  the  demonstrations. 

(b)  The  lectures  would  first  emphasize  the 
ethics  of  all  nursing,  the  first  great  principle  of 
which  is :  That  all  nursing  is  confidential,  and 

174 


AND  HOME  NURSING 

that  to  betray  the  confidences,  weaknesses  or 
whims  of  the  patient  is  forever  an  unforgivable 
sin.  Then  would  come  a  little  bacteriology, 
asepsis,  first  aid,  sanitation,  ventilation,  conta- 
gious disease  nursing,  diet,  obstetric  nursing 
and  the  care  of  the  baby ;  and  the  giving  of 
medicine  with  scrupulous  accuracy,  especially 
hypodermics. 

(c)  The  demonstrations  would  include  bed- 
making,     bandaging,     bathing,     fomentations, 
plain   urinalysis,   temperature,   pulse,   respira- 
tion, water  treatments  of  all  sorts,  and  all  the 
manifold    phases   of    surgical   cleanliness — in- 
sisted upon  constantly. 

(d)  After  some  weeks  of  work  as  outlined 
above,   the  lectures  and  demonstrations  in  a 
longer  course  would  deal  with  the  higher  tech- 
nic  of  the  operating  room,  both  surgical  and 
obstetric. 

(e)  In  order  to  make  ideal  home  nurses  and 
housekeepers,  the  pupils  would  do  nearly  all  the 
work  in  the  hospital.     Each  pupil  would  have 
a   short  turn   at  every  sort  of   work.     They 
would  eventually  do  all  the  cooking  and  serving 
in  the  house.     The  work  would  cover  the  entire 
range  from  scrubbing  floors  and  cleaning  house, 
to  the  most  artful  cooking  and  assisting  at  the 
most  delicate  surgery. 

6.  The  pupils  would  pay  say  $5.00  for  a 
short  course  of  6  or  8  weeks,  and  $10  to  $25 
for  a  course  of  16  weeks — really  in  advanced 
instruction. 

175 


CADET  NURSES 

The  instruction  would  be  given  by  the  highly 
trained  nurses  and  the  doctors;  it  must  never 
be  slip-shod  but  always  painstaking  and  thor- 
ough. In  a  year  some  of  the  advanced  pupil 
nurses  could  be  utilized  for  some  of  the  teach- 
ing. 

Pupil  nurses  (or  Cadets)  would  be  given  cer- 
tificates for  courses  taken,  and  after  receiving 
such  would  be  ready  for  outside  calls  for  serv- 
ice in  selected  cases. 

It  would  be  desirable  that  women  applying 
for  this  work  should  have  already  a  grammar 
school  education.  This  would  probably  eventu- 
ally be  insisted  upon. 

This  plan  I  believe  to  be  workable  in  most 
towns  of  ten  to  twenty  thousand  people,  of  a 
mixed  community.  It  might  need  to  be  modi- 
fied in  various  ways  to  suit  circumstances. 

The  great  purpose  that  should  never  be  lost 
sight  of  is  (1)  to  furnish  hospital  care  to  many 
people  of  small  means — as  well  as  good  nursing, 
at  moderate  expense;  and  (2)  to  educate  most 
of  the  women  of  many  households  to  be  good 
and  effective  nurses  for  their  own  people  with 
the  commoner  sicknesses  and  accidents  of  life, 
and  to  be  grounded  in  the  principles  of  clean- 
liness, asepsis  and  good  hygiene. 

The  hospital  would  be  a  practice  school,  like 
any  other  practice  school  in  an  educational  sys- 
tem. Here  it  would  give  practice  in  good 
housekeeping  and  nursing.  The  hospital  would 

176 


AND  HOME  NURSING 

be  largely  a  free  one  for  selected  needy  per- 
sons ;  patients  able  to  pay  moderate  rates  would 
do  so.  These  rates  and  the  fees  from  the 
pupils  would  go  far,  and  might  be  sufficient,  to 
sustain  the  institution.  A  generous  public 
would  take  care  of  any  small  deficit  in  a  work 
so  manifestly  helpful  and  needful. 

This  plan  means,  of  course,  intensive  train- 
ing in  a  new  education  at  a  teachable  time  of 
life  for  women  who  are  avid  to  be  equipped 
in  a  new  art.  With  the  demonstrations  and 
actual  practice  that  go  along  with  the  teaching, 
the  plan  is  sure  to  be  successful.  Hundreds  of 
instances  during  the  Great  War;  the  experi- 
ences of  all  manual  training  schools  and  of 
working  laboratories  all  over  the  country,  have 
shown  that  this  sort  of  intensive  training  is 
always  successful  because  it  is  always  enjoyed. 
It  is  the  only  plan  by  which  new  habits  in  any 
art  can  be  acquired  quickly — and  the  wonder  is 
that  educators  in  many  lines  have  been  so  slow 
to  adopt  it.  During  the  war  in  thousands  of 
instances  we  drilled  raw  recruits  to  be  good 
gunners,  successful  assistant  engineers  in  ships, 
even  in  battleships,  and  successful  nurses — 
all  in  the  space  of  two  or  three  months.  We 
can  do  similar  things  in  civil  life,  for  it  is 
founded  on  human  psychology — human  nature. 
The  cells  of  the  brain  and  other  nerve  centers 
acquire  new  habits — otherwise  new  automa- 
tisms— at  a  rate  geometrically  proportionate  to 

177 


CADET  NURSES 

the  rapidity  of  the  repetitions  of  a  new  move- 
ment. And  the  old,  contrary  habits  are  driven 
out  or  repressed  at  the  same  rate. 


178 


To  E.  P.  R.  on  Attaining  His 
Seventieth  Year 


To  E.  P.  R.  on  Attaining  His 
Seventieth  Year 


From  your  grand  Sabbatical  milestone  it 
seems  a  long  way  back  to  your  early  discovery 
that  your  toes  were  good  things  to  play  with 
and  to  put  into  your  mouth. 

Various  epoch  stakes  have  marked  the  jour- 
ney— your  boy  griefs  and  pleasures,  your  first 
job,  your  first  love  affair  and  your  first  baby — 
your  professional  promotions  and  sense  of 
power.  The  years  have  rushed  because  you 
liked  your  work  and  succeeded,  and  knew  the 
sun  was  always  shining  somewhere.  Your 
power  to  consider  the  essentials  and  neglect  the 
trifles,  have  kept  your  goal  always  in  sight. 

You  early  learned  that  truth  does  somehow 
consist  with  the  universe,  and  that  has  swept 
away  many  difficulties. 

You  have  read  the  sages  and  become  one  of 
them  yourself.  You  have  seen  the  pictures  and 
flowers  by  the  way,  and  heard  the  music  of 
childhood  and  song,  and  of  the  voices  of  a  host 
of  friends  that  you  have  made  because  you  are 

181 


TO  E.  P.  R. 

full  of  the  nectar  of  friendship  yourself ;  and 
you  have  lightened  the  tedium  of  toil  by  some 
gentle  satire  and  roguish  wit. 

Rugged  friend  of  friends,  friend  of  all  the 
people,  maker  of  history  and  prosperity — with 
the  modesty  of  greatness  and  proof  aeainst 
flattery;  may  you  go  on  in  work  and  play, 
at  least  to  your  next  decennial  milestone,  with 
all  the  joys  of  earth  and  the  blessings  of  God. 


182 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 
Los  Angeles 

This  book  is  DUE  on  the  last  date  stamped  below. 


orm  L9-42m-8,'49(B5573)444 


THE  LIBRARY 
UNIVERSITY  OF  CALIFORNIA 


Ill  Illl  Ill"  Hill ""' '"" '         ,,nn 

A    001  354  533    o 


Rll? 
B?6in 


